TRADE Application# /1 l P,%7 Z6/C/
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: /Lilly i +� Phone: 9/0 514
Owner (s) Mailing Address:: / 5 TE4 24 . f� / t )C. Z$ ' ,3 Z3
Land Owner Name (s): 79N4. Phone:
Construction or Site Address: /9/ M t,ThS a s t 01 R,,g4 LCtlE( - Alt • ZP3z3
PIN or Parcel # from GIS: / Z 4 7 o0 74 //5- - - 7 792 , 000
Job Cost: 2 Description of Work to be done k F Q. �c tG l4Tco��L
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 Lillington: 'II L
- 2-113 I I I Q- u 1 .4- e M!' si r r . L i t-ttlt i S lS c= 1 Er+
I- n M p snti! 1 ' A-4 ,, rs n« T. !3 ��--
Subdivision: Lot #:
I � � a7/fir will provide the T labor on this structure.
(Contractors Name) (Trade) I /
I am the building owner or my NC state license number is 4 & ioGe4ez , 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 loc• laws, ordinan -s - • • eg A - tions.
Structure owner(s) signature: _ -- Off 1 . -. Z/ /
7.4// (
01011/1111/ !!!
C Phone:
ompany ■ :me: _
i
C'
Codress. 'ow
Con - ctor' - License •:
C• tractor'• Sig . ure: D�
Wir
*Company name, address, & phone must match information on license.
Individual Trade Application 1 of 1 06/10
A PLUS FARMS INC. 0 4 w
give the tenant Ni u- L '
I the landlord J� `� d t - - t � ,
permission to put an electrical service on my property. This service will be used to power
a center pivot irrigation system. The tenant assumes all liability for this equipment.
a a �• 0 2S -- 11
, Dat
Landlord: - i —
Date:
Tenant: