TRADE
d 9 dd~~6
Centra l Pe Application#
Please note if this application Mail Harnett In County application
Permitting
wisith part a er in progress PO Box 65 Lillington, NC 27546
open permits. Telephone Number 910-893-7525 Fax 910-893-2793
_yes no _ www.harneft.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
i Kent Johnson will complete the Mechanical-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 Road Dunn, NC 28334
Street Address: Same
Business Phone: 910-897-5501 Email Address:
*Company name, address, phone must match information on license.
Land Owner's Name: 0 PI' d " Jogb Infor t I n Phone: q 0~~~ - a~ r a
Tenant/Building Owner(if different : sylak Phone:
Construction or Site Address: W Xi n ~t%A!&M PA 'DIM
PIN or Parcel # from GIS:
Specific Direc i ns to Job from Lilli n: I~
on `li C-NolL 6''
Description of work to be done: w „ yA + D(k p ob Cost: 5 00
Mechanical: New Unit With Ductwor _ New Unit Without Ductwork _ Gas Piping
ElectQcal: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect - Other
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
/ Permit Cost
Permit Fee: $ 195 (calculated from fee schedule)
Mail In Processing Fee: 3.00 era Ilcation
Total Enclosed: $ <R , 00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: ':7t I W09
DO NOT SEND CAS INCOMP E E APPLICATIONS WILL NOT BE PROCESSED.
T 10106
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MELVIN ALMAN W & E
1177 CHICKEN FARM ROAD ;
DUNN
NC
_ {283340000 H
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y 1516-13 3344.000
y~ 021526 0750
aim 0023277
MCKAY EXT AVS 001790 X
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ite Information
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d1 PID PIN LEGALI LEGAL2 ~PROPADDRS5,ASSESSACREiD6001C DP AGE
LOT#30
12080644 0017 33 0644-47-FOREST MAP#2002-1137 KINGSBROOK 1 02179 0069
3123.OOQTRAILS PH1 CR 000470 X
2080645 0022 0645-31-1 ACRE J H CHRISTIAN '1
2997 000ROGERS LIGHT RD X
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