TRADES Application #.l / ij 0
Please hole if this application Mall In application is pare of a job in progress Harnett County Central Permitting
�q �
with open permits. PO Box 65 Lillington, NC 27546
Telephone Number 910 - 893 - Fax 910- 893 -2793
yes no www.harnett.org
Certification of Work Performed
By Owner /Contractor
Contractor Information
' Kent Johnson
I. will complete the . 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 & Air, Inc.
Mailing Address: 724 Turlington Rd Dunn, NC 28334
Street Address: SAME
Business Phone: 910 897 - 5501 Email Address: Jm28334 @ao1. com
'Company name, address, & phone must match information on license.
Job In o m.tion q
Land Owner's Name: • • .• I 1 1 IN N AA t 1 Phone: * I -7 ' '
Tenant/Building Owner(if different): .i� Phone: SAtnb.
Construction or Site Address: 4)(0 Ac1i ilk WI PA 1) RInifm 1 11 G art 5 (0
PIN or Parcel if from GIS:
S cific Direc ohs to Job from Lillie to .
)
• ii on of work to be done: I n ����'� 1 6 1 -4 L -��
Description k J o Gas st Pi n
Smi .0 0 p�pgx .
Mechanical: New Unit With Ductwork- Newlin ft Without Ductwork
Electrical: 200 Amp <200 Amp p i g —
P p _ Service Change — Service Reconnect _ Other _
Plumbing: Water /Sewer Tap _ Number of Baths _ Water Heater
n Permit Cost
0 Permit Fee: $ • (calculated from fee schedule)
Mail In Processing Fee: $3.00 per application
Total Enclosed: $ (i)!) , no
Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP)
PO Box 65
Lillington, NC 27546 ++
Contractor's Signature: Date: t11 10 10
DO NOT SEND C H. IN OMPLETE A P LICATIONS WILL NOT BE PROCESSED.
10/06
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