TRADES Application # /e Q0
Please note if this application Mail County C application 01 0°;V
/ �
Harnett County Central Permitting O i
is part of a job in progress PO Box 65 Lillington, NC 27546
with open permits. 910- 893 -7525 Fax 910 - 893 -2793
yes l'• no . www.harnett.org/permits
Certification of Work Performed by Owner /Contractor
. (Individual Trade Application)
I 1 (� Contractor Information
1, LJ .C_, A II LED _:,. will complete the HVAC work on the project or
(Name) (Trade)
structure herein described. My state license number is 4412 . All work shall comply with the State Building
Code and all other applicable State & Local law, ordinances and regulations.
Company Name: M & H Heating & Air Conditioning, Inc. _ _ _
Mailing Address: 126 S. Fuquay Ave Fuquay - Varina, N.C. 27526
Street Address: 126 S. Fuquay Ave. Fuquay- Varina, N.C. 27526
Business Phone: 919 -552 -9223 Email Address: ellenallred @embargmail.com
*Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: Carol Siefer Phone: 919 -639 -3944
Tenant/Building Owner (if different): Phone:
Construction or Site Address: 83 Vuncannon Drive Fuquay- Varina, N.C. 27526
PIN or Parcel it from GIS:
Specific Directions to Job from Lillington:
Take Hwy 401N. Go 7.5 miles. Turn right on Chalybeate Springs Rd. Go 2.5 miles. Tum left on Atkins Rd. Go .2 mile. Tum right or
on Vuncannon Drive
Description of work to be done: replace heat pump system Job Cost: $5538.00
Mechanical: New Unit With Ductwork _ New Unit 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: $ 65.00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per lob For Electrical Permits with Progress Energy we
need the premise number provided.
Total Enclosed: $ 68.00
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
/y Lillington, NC 27546
Contractor's Signature: 4Y" _ Gl' 00b D Date: 1 1/ '4110
' * *DO NOT SEND CASH. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED **
Individual Trade Mail In Application 1 of 1 04/10