TRADE
Application # 0 9 BOO S fO-,5d/
Please note o this application Mail Harnett In County application
Central Permitting
with is part of open pe perrmititsprogress PO Box 65 Lillington, NC 27546
.
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 complete the Mechanical-H"C 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.
ob Information
Land Owner's Name: U1Z.Mj1 ,n CLAJA~A Phone:%-ggq-bq(9'L
Tenant/Building Owner(if different): ~'As£. Phone: SgrV\i. f
Construction or Site Address: ~~J~~ ~iA~hC1`4. Y.C► C1){~ ~L~ nC M-3
" PIN or Parcel # from GIS:
Specific Directions to Job from Lillin ton: n
~tal ~
w T~ a°t\. AW\j 0 LTV-(~s5 \K 1011
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Description of work to be done: Af Qt Job Corst:L d do, UV
Mechanical: New Unit With Ductwork _ New Unit Without Ductwork _ Gas Pipi g _
Electrjcal: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ t9`b ~ ~
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546 II
Contractor's Signature: 44"', Date: 16 4 I
DO NOT SEND CA . INCOMPLETE APPLICATIONS WILL NOT BE PROCE SED.
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