TRADES Application # `eO 400741 3 2
Please note if this application Mail In application
is part of a job in progress Harnett County Central Permitting
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
1 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 6 Air, Inc.
Mailing Address: 724 Turlington Road Dunn, NC 28334
Street Address: Same
Business Phone: 910 897 - 5501 Email Address: , ` 4 • :•
*Company name, address, & phone must match information on license.
Job Information
Land Owner's Name: t ?ss\s kfikne., Phone: qi0 W1 aa00
Tenant/Building Owner(if different): Std , c� Phone: S1>0&2_
Construction or Site Address: 4q:F Nit11\ j.VFi— t'>zta1l Rd EIW:1In \c. Daq
PIN or Parcel # from GIS:
.ecific Directions to Job from Lillington: A cI
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Description of work to be done: l (gy �i1Pf��� ti Vii C , Job Cost: t' q
Mechanical: New Unit With Ductwor� 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: $ (05 , 00 (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ (D9 1
Make check payable & Mail completed application form to: • Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
/
Contractor's Signature: 6,41 F4 i t \ VP Date: q 196 I I
DO NOT SEND CASH. IN � OMPLETE APPLICATIONS WILL NOT BE PROCESSED.
10106
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