TRADE
f o 073 ~Co d
=iflhis ation Mall In appllCatlOn Application#
ss Harnett County Central Permitting
PO Box 65 Llllington, NC 27546
Telephone Number 910-893-7525 Fax 910-893-2793
www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
Kent Johnson
will complete the 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 Rd Dunn, NC 28334
Street Address: SANE
Business Phone: 910-897-5501 EmailAddress: jm28334@aol.com
'Company name, address, & phone must match information on license.
Land Owner's Name: 0 ob Information Phone:Qlb-%93- 44gq
Tenant/Building Owner(if different : A Phone: 5 - - Q 4
Construction or Site Address: ` a7Jr-a
_PIN or Parcel # from GIS:
ecific Directions to Job from Lillian ton
r~ f1I Yrt*RDOn~ ll-J (~t1 ~(i`d, ~t(
Description of work to be done: o411giQ1 ~ Job Co""N(
st: IOOO .00
Mechanical: New Unit With Ductwork New n-It-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: $ .0(J (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $--(a% . In
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date: cq I9//0
f
DO NOT SEND CAS . INCOM LETS APPLICATIONS WILL NOT BE PROCESSED.
10/06
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