TRADE Application # `L 572 v 2 (✓ "
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
(Individual Trade Application)
Owner (s) of Structure (c 6e yt et7 Phone 2/ 5 - i 9, 4 6 77
Owner (s) Mailing Address 3 6-2s_ 22w.oSo,v Rel
Ali /P,C .cJC - 7 2S - o/
Land Owner Name (s) Phone
Construction or Site Address 6 i• e,iso. : - r e. .✓c -2 7 -re /
PIN or Parcel # from GIS (0-1 04 - 906,9 01 ,2475 41-7252 ` 90,
Job Cost /8 Description
n of Work to be done Cli n-.7 c. Set if r< r
1 SO O A,w.tO -3 t }
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 Lilhnaton } 11 fJ
mac/ 7/� ry //cc. � sr< / d r/- �� o
A x./ Rk,t) v 4 , /cFY
Subdivision // // Lot #
I f2 4 GkC' „a i ar,ii will provide the �/ //Z °,�/ labor on this structure
(Contractors Name) (Trade)
I am the building owner or my NC state license number is 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
St , .i ure o :r(s - •n. ure _ � _ � _ Pate Sr or
Company Name k./1 . 6 764- 3 Oat r 41- Phone 9/0 - 9t9-‘93a
Address /"Pie /VC 2? ttL K (i //. �v. County A/iati e7 /
Contractor's License # 2/ 7(7 —A—e— Email A / ddress /t'.rp eft, / 76 4`/c4 z "" / °~"
Contractor's Signature r 0 Date o3/,4 Z ///
Company name address & phone must match Information on license
Individual Trade Application 1 of 1 08 /10