TRADES
! Application# 09 p~00
Please note this application Mail Harnett In County application
Central. Permitting Co
. is w part ajob its. progress PO Box 65'Lillin ton `NC 27546
with open permit 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-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: 910-8975501 Email Address:
*Company name, address, & phone must match information on license.
,j~~ J b Inf rmation r~,f
Land Owner's Name: O 1 C A PhoneRO 10~'' M
Tenant/BuildingOwner(if different): 5 Rffi1~_ 1 Phone:
Construction or Site Address: ~AO 1 U\ _ ~~~Scp~ N fiU (~31{
PIN or Parcel # from GIS:
S ecifi' Directions
pjr to Job from L' in t: n ; 1~ (D ~bf
1L Q.
i IF 0Y\ le) I K0 A,4
Description of work to be done: Job Cost f q Q~. V a
Mechanical: New Unit With Ductwor `New Unit Without Ductwork _ Gas Pilling
_
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: $ (v~ + bl~)
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546 ~ 2
Contractor's Signature: Date: Q/3 R
DO NOT SEND CAA.- INCO PLETE APPLICATIONS WILL NOT BE PROCE SED.
10/06