TRADES
Application # Please note if this application Mail In application
Harnett County Central. Permitting
wisith part of open aiob permit its. progress PO Box 65 Lilliegton NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
yes no www.harnett.org
Certification of Work Performed OI I
By Owner/Contractor
Contractor Information
Kent Johnson
4 I, 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.
1
Land Owner's Name: formation Phone: (V11- t -5&5V11--'
Tenant/Building Owner(if different : Phone: 91cl' tJ (:Fj
Construction or Site Address: 1 a2a U~tlIL1 F V~ -GrW1 O Ed Ei-fa ll A 3q
PIN or Parcel # from GIS:
S ecific Directions to Job from Lillie n:
011 ath -Am Em 111 Cass my- 6VEt
Description of work to be done: wq,kkl 0{1 Job Cost: Ot 5 M , 00
Mechanical: New Unit With Ductwork-4 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: $ (fl5 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 60S u 6
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PC Box 65
Lillington, NC 27546
Contractor's Signature: f 2ti Date: (II~1~~6q
DO NOT SEND CASH. INCOM LETS APPLICATIONS WILL NOT BE PROCESSED.
10/06
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