TRADE Application# /I Soo Z5 9? C
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
r� (Individual Trade Application) LPN- �1
Owner (s) of Structure: L7VIuV1 - It YYIa(Shc�.1hQrricjS Phone: I(l) LPN- d87G
Owner (s) Mailing Address: Haas Adtocr. Rd
Lillinpn NC 275410
Land OwnerName(s): 'rrvrM kr WICaerc i∎oss Phone: Rici- L1
Construction or Site Address: 11 'Told Conan On 1 Brixtd Loa y KC a7SoS
PIN or Parcel # from GIS: ) j
Job Cost: Description of Work to be done r61 de, < 7-- 7;,eve
rm.' !e^ 11/4 ,1411/2 110 Pap
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping
Electrical *: 200 Amp _ <200 Amp • Service Change 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 Lilli aton: I e{ t /�
9 1 &nom cJ -turn I h db _Fronk spew £ rc depf cn h6
Mt I\1.6, rnl i LL Ad , R rst mod (7) ri SVtt - 11 :T <arna.n Lx, ) "J .
1 l
Subdivision: I Lot #:
I 1 T ✓vn e.. will provide the kit , Cal labor on this structure.
(Contractors Name) (Tr'ade)
1 am the building owner or my NC state license number is 015 ITu which
perform such work on the above structure legally. All work shall comply with the State Building entitles me Code to
and all other applicable State and ocal I ws, ornc and regulations.
{ Structure owner(s) signature: • (6 a. ( ° L ts Date: a\ c 1) I 1
Company Name: v t S �t e C ; r / Jef., Phone: Q 1l7 -S9 3- 514
Address: \ - M 0 tOXt nQ 5 ("OAS • �.prirt (no Plf . County: Cr t,tm 6¢,t la.a.ep
Contractor's License #: O'1 c. \ O - U Email Address: ?Dul e, P t eC OQ. C t)n
ontractor's Signature: �.. - Date: 2 j 1
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06 /10