TRADE Application# /1 C 2Z/
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
910 - 893 -7525 Fax 910 - 893 -2793
www.hamett.org/permits
Certification of Work Performed By Owner /Contractor
(Individual Trade Application)
Owner (s) of Structure: j FF At r2 Phone: 9/ or /, atlg
Owner (s) Mailing Address: L/, 5 j -
240 at _ __ � me a 3
Land Owner Name (s): ■ (EPP A-ore y Phone: ' 'O - w -eo9g
Construction or Site Address: / � Y0. t- ,?/O S �3v ti,�r /TYF1 / zg323
PIN or Parcel # from GIS: a o,7 Oa 35
Job Cost: _________Description of Work to be done -kJ' Elia_ - Taverz2_rn! Pump
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 Lillin ton:
CL-07-5 iJc . — Li 0
Subdivision:
h / / Lot #:
I /16 PWIl // »�,, will provide the L L labor on this structure.
(Contractors Name) (Trade)
I am the building owner or my NC state license number is its 00-671 , 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 I , ordina s a regulations.
Structure owner(s) signature: ` Date:
J *C/
nCompany Name: Phone:
Address a It County:
C. tractiir's Lic- se — Email • ddress:
Contractor ignatur • Date:
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10