TRADES Application # /5 r-G 0 4 1 L:s‘
Mall In application
Please note if this application Harnett County Central Permitting
is part of ajob in progress PO Box 65 Lillington, NC 27546 Q
with open permits. k
Telephone Number 910- 893 -7525 Fax 910 - 893 -2793 � $
yes no www.harnett.org Cii:
Certification of Work Performed
By Owner /Contractor
Contractor Information
Kent Johnson will complete the Mechanical - HVAC work on the project or
(Name) (Trade) 1
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 & Air, Inc.
Mailing Address: 724 Thrlington Road Dunn, NC 28334
Street Address: Same
Business Phone: 910 897 - 5501 Email Address: - -. ;`:'
*Company name, address, & phone must match information on license.
41C,(k ° ec' Information
Land Owner's Name: (��o' p I -3587
t; ill Phone: • Tenant /Building Owner(if different): nick k Phone: c 114 ,
Construction or Site Address: a S( t J (r r l t i T-R frl, RP,i OKI n C, AY��.39
PIN or Parcel # from GIS:
�J 1
age 'fit Directions to Job from //�illin tont'on: 1 p p 1 1t(�� , t '/ t /� ) ry I
Description .1 p tion of work to be done: IJIIAR »'0\ thi4 O ty Job Cost 1 11000, DO
Mechanical: New Unit With Ductwor New Unit Witho t Ductwork"/ Gas Piping
Electrical: 200 Amp _ <200 Amp _ Service Change _ Service Reconnect _ Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
/ _ Permit Cost
(.0 Permit Fee: $ (.05 , 60 (calculated from fee schedule) _
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ ( Q9 ) o (� Q
Make check payable & Mail completed application form to: • Harnett County Central Permitting (HCCP)
PO Box 65
/ Lillington, NC 27546
Contractor's Signature: ' . Date: I II 3110
DO NOT SEND CASH. INC el PLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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11/8/2010