TRADES Application # /101.770 0 Arlo
Mail In application
Please note if this application Harnett County Central Permitting
is part of ajob in progress PO Box 65 Lillington, NC 27546
with open permits.
Telephone Number 910 - 893 -7525 Fax 910 - 893 -2793 VI �r
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: JGM Heating G Air, Inc. i
Mailing Address: 724 Turlington Road Dunn, NC 2833
Street Address: Same
Business Phone: 910- 897 -5501 Email Address: - -- = -.°
`Company name, address, & phone must match information on license.
�rr Job Information 11 r1 p.� c�
Land Owner's Name: A lu� ta��n lc R_ Phonect(Q 4�iga- DJq A
Tenant /Building Owner(if different): SD1(vE. Phone: $r'v ,E,
Construction or Site Address: 5U.0. c 2* r. 41 T ut r1, fled A8.3.-34/
PIN or Parcel # from GIS: J
I
5.- . fie s'r- lions to Jo. from Lillin•ton:
I.
ii t:�7iTiTi�wimilril 0 30 0 ca 11— ` t ' a.J�L.Lo •
—Sak I— I Y0/ (xr1196
Mechanical: of New Unit With Ductwor?tyv New Unit Without Ductwork Job Gas � I `J60 rN)
Piping
Electtical: 200 Amp _ <200 Amp Service Change _ Service Reconnect _ Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
r �n Permit Cost
Permit Fee: $ (o5 t60 (calculated from fee schedule)
Mail In Processing Fee: $ per application
Total Enclosed: $ 7 i 00
Make check payable & Mail completed application form to: • Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546
Contractor's Signature: W Date: �I � I ( 0
DO NOT SEND CASH. INCO PLETE APPLICATIONS WILL NOT BE PROCESSED.
10/06
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