TRADES Application # / 1 0a0/70405- 0
Mall In application
Please note if this application Harnett County Central Permitting
is part of a job in progress PO Box 65 Lillington, NC 27546
with open permits.
Telephone Number 910 - 893 -7525 Fax 910- 893 -2793
yes no www.harnett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
I 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
0 .. State Building Code and all other applicable State & Local law, ordinances and regulations. __
Company Name: J01 Heating 4 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.
*4 I nformation
Land Owner's Name: at5 hnq Phoned (O s M `
Tenant/Building Owner(if different): c Jl ' > ` YYI� Phone: ShrtiL
Construction or Site Address: a`zok ty�t,\ t'd.._- c 1h (t(', gs
t
PIN or Parcel # from GIS:
Sse i is Directions to Job from Lillin fito y$.
I etc, �1 11 41 ow t1.. .4 1 I9� 4
is V\\ a J 1 . ' area �1'ew Ci ►�� ,i_
Description of work to be done: C.� e \iW ', iNe ' � U'� • Job Co 5 00' op
Mechanical`. New Unit With Ductwork New Unit Without D ctworkN 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: $ (..Q i b0 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ LO% , ' WI )
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: Dat I I0
DO NOT SEND CA H. INC PL� PLICATIONS WILL. NOT BE PROCESSED.
10/06
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