TRADES Application #/Q SD 6
Please note if this application Mail In application rJ�6j
is part of a job in progress Harnett County Central Permitting p�
with open Hermits. PO Box 65 Lillington, 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
1 . will complete the HVAC work on the project or
(Name) (Trade)
structure herein described. My state license number is 1716 . 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: SAME
Business Phone: 910 897 - 5501 Email Address: Jm28334 @aol. com
*Company name, address, & phone must match information on license.
`` a • Job Information qt0 Q
Land Owner's NamenDOtn ) &F&` Phone:gi93 — 300
Tenant/Building Owner(if different): �pYC� • Phone:
Construction or Site Address: IQ, Q� •+ LAX `L Vt.\ --78(644egni n(
.PIN or Parcel # from GIS: ►�
'ecific Directi.ns to ob from m Lillin
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Description of work to be done: CL .x.33 CU N V R C \ Job Cost: "� If-
t d� 0 t
Mechanical: New Unit With Ductwork New Unit Without Ductwork N/ Gas Piping _
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other_
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
• ^ (� Permit Cost
r
Permit Fee: $ W16 a (calculated from fee schedule) •
Mail In Processing Fe F: $3.00 per application
Total Enclosed: $ to% s tA
•
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
d PO Box 65
Lillington, NC 27546
•
Contractor's Signature: 0 Date: S l it (�
DO NOT SEND C H. INC / PLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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