TRADES
1 Application #e-11J1 %.::TG
Please note o this application Mail Harnett In application of a County Central Permitting
with open permits. is part progress PO Box 65 Lillie9ton, NC 27546
e
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 will com lets the Mechanical-HVAC
p work on the projector
(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: 910-8975501 Email Address: - "
'Company name, address, & phone must match information on license.
Job Information `~l b~ q3 - 5 a~
Land Owner's Name: CNILD Phone:
Tenant/Building Owner(if different : Phone:
Construction or Site Address: 5
PIN or Parcel # from GIS: C a ~3
Specific Directions to Job from Lillington:
F-0 PA c~- 4P(hy
Description of work to be done: ` tl'Wr ~ 1 1~ (7gpS IPf Job Cost
:
Mechanical: New Unit With Ductworlty_ New Unit Without Ductwork _ Gas Piping
Electrjcal: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect - Other
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
Permit Cost
Permit Fee: $ o o_ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: ~JIILJ- Date: I0 d
DO NOT SEND CA H. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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