TRADE
Application # r~ ~0~00
Please note this application Mail Harnett In application
is County Central. Permitting ~Ud /
with art of open ajob peanit its. progress PO Box 65 Lillie9ton, 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 com lete the Mechanical-HVAC
p 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 g 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.
J nformation O ` -
Land Owner's Name: (x C1 Phone:
Tenant/Building Owner(if different : Phone: Sl>
Construction or Site Address: (Jd
IN or Parcel # from GIS:
P16k
S ecific Directions h Job from Lillie o o (t
UJ.kA ~I
Description of work to be done: 01, 11,,nd Job Cost%GD • ~0
Mechanical: New Unit With Ductwork New Unit Without Ductwork _ Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect - Other _
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
Permit Cost
Permit Fee: $ 5, a D (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ Up2 a o O
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: 3
DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
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