TRADES Application # /el -ci ' O
Please note if this application Mall In Centr l Permitting c5 '
is part of;,job in progress Harnett County Centrermitting CMG
with open permits. 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 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: JP,M Heating $ Air, Inc.
Mailing Address: 724 Turlington Road Dunn, NC 28334
Street Address: Same
Business Phone: 910 897 - 5501 Email Address:
*Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Aati I oKPR Phone: 9.3 —WA 35
Tenant/Building Owner(if different): pp arm.. Phone: 11
Construction or Site Address: X14 to FJ+4not? - f m.h R-A mil knA9l Et f it a2g3a J
PIN or Parcel # from GIS:
S.eci is Directions to Job from Lillin..n: , ► d G ,
+
- I • rat... irk furi(' - I �� . L • r .A
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111111.1111nl 1 1 I t _ • tI»
Description of work to be done: 7.:;" VA C a u Job Cost: "k �OO� , 00
Mechanical: New Unit With Ductwor� New Unit ith ut 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: $ ��J . 00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ 1 rn9 , Q O
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: -601- Q �� Date: 5 t an l l t O
� � V1
DO NOT SEND CAS /NCO LETS APPL CATIONS WILL NOT BE PROCESSED.
10/06
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