TRADE 01/20/2011 10:00 9196620730 ALLEN KE LL Y CO INC PAGE 01/01
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Harnett County Central Permitting
PO Box 65 Liliington, NC 27546
• Telephone Number 910- 893 -7525 Fax 910 -893 -2793
•
www.harnett.org
Certification of Work Performed By Owner/Contractor
Owner (s) of Structure: S kat d" Pf a r re It b Lunt L, Phone: 919 - 5 5 2 - 1010
Owner (s) Mailing Address: '1 1'l I C k a I1 b c a +c S P r �►. R4c •
Fc�vn1 vorjrr{ NC 1152G
Land Owner Name (s): ¶.0 4 d - Flo yeti f -0,C,., Phone: 5 S Z - 10 ) Tt
Construction or Site Address: 1 '11 H II CL o l I3 € alc s f ., c n d
PIN or Parcel #; 0 g(,
Job Cost: 510 5 Description of Work to be done R L11(a c t- h c n I- cam?
hat, • ci a it, ati ell a l'
Mechanical: New Unit With Ductwork New Unk Without Ductwork _1 Gas Piping _
Electrical: 200 Amp _ <200 Amp Service Change Service Reconnect ` Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
Specific Directions to Job from Lillinoton: 4 s ,
• 1 0( 1V to 12.. a.. U-,ti11 hea+s. .s ri,g4 ill
Subdivision: Lot*:
•
I aah K. have provided or will provide the it V AC Ckao. y. o µ r labor
(Contra Name) (Trade)
on this C struc p t q uzee. I am the building owner or hold a NC state Me chric.1 / IM fit, art f c6 I license
(Trade)
number 11 010 , 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.
ef . er(s < gn - re: ate: lad
Company Name: RIta•, Ke11.3 al, -o Phone: 11a -11a ^ 117
Address: 1),(1 -Ft Tr10" Rd (Ulf ;3%, NL 11603
County: W I1/41( F Contractor's License #: t' altAl2.1 11: 0/0'11
Contractor's Signature: � J .4L Date: (1 tV /2Q11
`Company name, address, & phone must match Informatlon on license.
12/06