TRADE Application* /1 5V 4 ✓ Y 77
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.harnett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application) .?_069?
Owner (s) of Structure: AQ1 e R. M do z4- Phone: 1i)
Owner (s) Mailing Address: . 25D0 0/ /. L 4a/it
Air 225z5 I
Land Owner Name (s): Phone: �
ne:
Iliac W�
Construction or Site Address: c K S P d ' it 4.6 z2
PIN or Parcel # from GIS: 0 7 'l 04 9 z 0. �4 92 - l% - 32 6/, 006
Job Cost: Description of Work to be done SQL 6 � N�.ttGi
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Piping
Electrical`: 200 Amp A <200 Amp _ Service Change me Service Reconnect _ Other _
For Progress Energy customers we need the premise number
Plumbing: Water /Sewer Tap Number of Baths Water Heater
Specific Directions to Job from Lillington:
2f' (i✓ 4,'€/ '7 (r›, 1
Subdivision: // / Lot #:
I t�t1Act Id (Add GM/ will provide the (6(', of / labor on this structure.
(Contractors Name) (Trade)
am the building owner or my NC state license number is 26 3 L , which entitles me to
perform such work on the above structure legally. All work shall comply with the State Building Code
and all other applicable State and local laws, ordinances and regulations. IF
S u tun • ner( 'enatu _ Ala / _ � I � DD-- =:
Company Name: a %P.t d oM eO2�(t Ya / / 641 G, Phone:�9 /%/ 1I 723 X88
Address: I VO a in 670/1 is At i,t County: f/a(At /t
Contractor's License #: .2 O P L Email Address:
Contractor's Signature: //� - -d-17/ Date: /l//I/!/
'Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06110