TRADES
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Application #
Mail In application
Please note this application Harnett County Central Permitting ~4 A 5q a3
with part ape o a job
permit its. progress PO Box 65 Lillington, NC 27546
w
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 'lurlington Road Dunn, NC 28334
Street Address: Same
a
Business Phone: 910-897-5501 Email Address: AMU-334 4985(, Cam
*Company name, address, & phone must match information on license.
e , J~ob nformatlon
Land Owner's Name: C Phone:
Tenant/Building Owner(if different ~ }!nu L Phone:q (0-VO-A556
Construction or Site Address: O~k US 4,4-1 MAGY1F 2~, n C a955 aL
PIN or Parcel # from GIS:
S ecifc Directions to Job from Lillin ton:
Description of work to be done: a OL~~ A~46n k? Job Cost: CJ I ~ D .
Mechanical: New Unit With Ductwor New Unit Without Ductwor Gas Piping
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: $13.00 per application
Total Enclosed: $ s
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: oL 4&., ~f Date: g
DO NOT SEND CA N. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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