TRADE
Please cote if this application Mall In application Application Harnett County Central. Permitting
GCS
with is part of open ajob permit its. progress PO Box 65 Lilliegton,' NC'27546
A/
Telephone Number 9107893-7525 Fax 910-893-2793 YI
yes no. www.harneft.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
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.
-~+r~ t Job Information
Land Owner's Name: i]1~t\~ A4 ~f-k Phoneq l~ 33q-%, .j;q
Tenant/Building Owner(if different : ~JA ,1 Mo`" Phone:
11 n 't
Construction or Site Address: k6r w 1 ~1 ~1AXt0.6n K `c~ llf (n
PIN or Parcel # from GIS:
S ec" Directions to J b f om Lillie ton
c ~a~i s. ~R o on
0
Description of work to be done: C~ s-.0('9aA 4~lJob CoP
C'
umst: o~ to 40 , 00
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork Gas Pipidg-
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
Permit Cost
Permit Fee: $ 4 00 (calculated from fee schedule)
Mail In Processing Fete: $3.00 per application
Total Enclosed: $ \O% a0r,5
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: r/1 Date: q(11/07
DO NOT SEND CAS :'INCOMP ETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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IPEELE JAMES TRAVIS &
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PO BOX 2325
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http://gistools.hamett.org/Freeance/ClienUPublicAccess 1 /index.html?appconfig=public 1 9/14/2009