TRADES
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Application #
Please note if this application Mail In application j
is part of ajob in progress Harnett County Central Permitting
CT/
with open permits. PO Box 65'Lillington,` NC'27546
Telephone Number 9107893-7525 Fax 910-893-2793
yes no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
Kent Johnson will complete the Mechanical-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 & 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.
I r ob Information
Land Owner's Name: 2w d- l- np J I1? Phone: Q10-W9i1-,5 (oAtn
Tenant/Building Owner(if differentLti-//)nR , nr Phone:
Construction or Site Address: ~q ~fTJe 7K art ~ U.t1X1 C, 01733
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PIN or Parcel # from GIS:
S ecific Dir ctio s to Job from Lillin tom- C 11~i~0--r
L A ~r',t ll w 1LA tfYt Pita 1gJ
Description of work to be done: (Ig~O ~~l tom. ~n - Job Costa
Mechanical: New Unit With Ductwor _ New nit ithout uctwork Gas Pipi g _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect- Other
Plumbing: Water/Sewer Tap _ Number of Baths _ Water Heater
Permit Cost
Permit Fee: $ n (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: 000
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: L Date: 101m lo
DO NOT SEND CASH. INCO PLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06