TRADES
Please note ifthis application Mail In application Application # Q
is part ofajob in progress Harnett County Central Permitting
With open permits. PO Box 65 Lillington, NC 27546 J
Telephone Number 910-893-7525 Fax 910-893-2793
yes _ no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
Kent Johnson
l 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: Jf,M Heating fi Air, Inc.
Mailing Address: 724 Turlington Rd Dunn, NC 28334
Street Address: SAME
Business Phone: 910-897-5501 EmailAddress: jm28334@aol.com
'Company name, address, & phone must match information on license.
I' b Information
Land Owner's Name:
, ~ J71~ ~ phone
Tenant/Building Owner(if different : Phone: MIL
Construction or Site Address: Lid AW3
/
YIN or Parcel # from GIS: ~IJ
S cific Directions to J from Lillin on:
C ~~11
~ JT
Description of work to be done:. C__ xn~~QU ~VA C, Job Cost T o00 , ~t7
Mechanical: New Unit With DuctwolP-
.~L_ New Unit Without Ductwork _ Gas Piping
Electrical: 200 Amp _ <200 Amp - Service Change - Service Reconnect Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
r Permit Cost
Permit Fee: $ u5; 00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ b Q R, Q
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: 1:31 J 0
DO NOT SEND C f INC MPLETE A PL/CATIONS WILL NOT BE PROCESSED.
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