TRADE Application 2 4i oo
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 G� /__. �... • �� Phone 0- L1 L'_ 0 0
Owner(s) Mailing Address G re i. ; -
33Z,
Land Owner Name (s) Phone
Construction or Site Address y . . �/�. ....... s .� /. ��M i_ / _
PIN or Parcel #from GIS %I' , — 2 — 7 7,4 °� r (✓� 9 �ba/ 2372 �pZ
Job Cost Descnption of Work to be done nn/1n �.1 �/no.( . , 59(
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
S.ecif c Directions to ob from Lillm•ton
I1M11111eES121111 A . _ _.
W W •
Subdivision !e, ,.r /id Lot#
I A S 2Jhn6 f will provide the /� L/l / labor on this structure
(Contractors Name) (Trade)
I am the building owner or my NC state license number is I 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 G I
/ _s ezn ii Date 7 �� — I
C rocripan Phone
Address —_ ounty
Contractor's License # - -i A.•r-
Contractor's Signature Date
ompany name address & phone must match Information on license
Individual Trade Application 1 of 1 06/10