TRADE (2)
Application #09 4_1~ 0
=Jobfii cation Mall In application
ss Harnett County Central PermittingPO BOX 65 Lillington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
Kent Johnson
I• will complete the HVAC work on the project or
(Name) (Trade)
structure herein described. My state license number is 17164 All work shall comply with the
State Building Code and all other applicable State & Local law, ordinances and regulations.
Company Name: J&M Heating & Air, Inc.
Mailing Address: 724 Turlington Rd Dunn, NC 28334
Street Address: SAME
Business Phone: 910-897-5501 Email Address: jm28334@aol.com
"Company name, address, & phone must match information on license.
j 1~`1 `l n Job I o ation Q o-gg a_ 4J~~~
Land Owner's Name: 1 \l~l ho~~~ _ Phone•
Tenant/Building Owner(if different : Phone:
Construction or Site Address:
-PIN or Parcel # from GIS:
S ecific Dir cti ns to Job from Lillin on,
u,tl fvvh" B qtr
~f Acr~Ss
Description of work to be done: 1~4~ Job Cost:%~3600,
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping _
Electrical: 200 Amp - <200 Amp Service Change _ Service Reconnect v Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $°Op (calculated from fee schedule)
Mail In Processing F e: $3.00 per application
Total Enclosed: $ ~QQ
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature' f9~I11~ Date: ~Jlnq_
DO NOT SEND CASrH: 1 CUMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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10215181518=43=ACRE .1705 NC SR 0.62 0 75470 SL
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0716101610-46- 1 ACRE
- BAILEY RD SL
21)034 1825 000561 NC 002083 X 1 00818 0286 21500 59850
http://gistools.hamett.org/Frecance/Client/PublicAccess 1/index.htmi?appconfig=public 1 8/24/2009