TRADE i720, c' it--- 867924 r / / / /�/ 0
I
Application # 1 / 5 O ! _ `� 942_
/�" 7 � . Harnett County Central Permitting
G / PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910-8g3-2793
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor
/ (Individual Trade Application) /�
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Owner (s) of Structure: Lori `ta .. Phone: / `7 - 7 -J�i
Owner (s) Mailing Address: PO. /3QX 7�
t o /'h , i c r4 --7S2i 1 � `
Land Owner Name (s): n P 11 ,32S Phone: �L� � r� c7J �!
Construction or Site Address: 4 2 /diint i A, ,)4An Ale d$.33 ¥
PIN or Parcel # from GIS: J-Z% - , - % ✓99,9 ✓ 2 ' Z 9 /0/ ✓/
Job Cost: Description of Work to be done / Z. / / /61/67 j54:6 A4
z"-9
Mechanical: New Unit With Ductwork New Unit Without Ductwork Gas Piping — .
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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 Lillington:
Subdivision: Lot #:
1 A gd/ F!
r will provide the labor on this structure.
(Contractors Name) (Trade)
1 am the building owner or my NC state license number is 5 4i '(P" 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.
Structure owner(s) signature: ot , Gaellfi[.. Date: 4)-- 61-1
Compan , _ - • Phone:
Address: ounty:
Contractor's License #: mail Address:
Contractor's Signa Date:
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10