TRADE
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Please note if this application Mail In application Application# Harnett County Central Permitting c~ Ce
is w part progress PO Box 65 Lillington, NC"27546
with open permits. Telephone Number 910-893-7525 Fax 910-693-2793
yes _no www.harnett.org
Certification of Work Performed
By Owner/Contractor
Contractor Information
Kent Johnson wifi 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: 910-897,5501 Email Address:
*Company `Company name, address, & phone must match information on license.
I ob In mation q (q_A+O_rlsya3
Land Owner's Name: ~Y1 h L„Q . Phone:
Tenant/Building Owner(if different): SPY►F~ Phone: Shal~l~
Construction or Site Address: ~1{ 0 r f is aE
PIN or Parcel # from GIS:
ific Directions to Job from Lillin ton:
Slag
u 30 \ES S i
Description of work to be done: Job Cosk4,g m 1(~~3 . 0_
Mechanical: New Unit With Ductwor New Unit Without Ductwork _ Gas Piping _
Electrjcal: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect Other
Plumbing: Water/Sewer Tap _ Number of Baths Water Heater
F R/~ Permit Cost
Permit Fee: $ 5s~V (calculated from fee schedule)
Mail in Processing Fe : $3.00 per application
Total Enclosed: $ 1 A C
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Date:
DO NOT SEND CASH. INCOMP TE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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OVICK CHRISTY TART 8 u
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HUSBAND
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3101 ERIC STREET !
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