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TRADES Application # /0 J & 0°T.Sa Mail In application Please note if this application Harnett County Central. Permitting Dif9Actig is part of a job in progress . PO Box 65 Lillin g ton, 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 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 g Air, Inc. Mailing Address: 724 Turlington Road Dunn, NC 28334 Street Address: Same Business Phone: 910 - 897 - 5501 Email Address: Maa )M( t CSMW *Company name, address, & phone must match information on license. Q ^ J ob l formation r1 Land Owner's Name: bb .l C �. �( Phoneq ( a �� ° . )'J I �c�. � "J Tenant/Building Owner(if different): SR I Phone: 1 Construction or Site Address: a(13 11 1, 11c ,/ RA U U1;11q't(1� (1C 09551} 6 PIN or Parcel # from GIS: J Specific Directions to Job from Lillin t n: - inv-t -hlrn -f 4 ai 46I ) Con Rol 414 I11cnnnAtl5 © 6f Tftraimitmnasitranuarzailh Cy Mechanical: New Unit With Ductwork V Unit Without Gas U 'at A ` • Description of work to be done: `>r W Job cos t: 5,900,00 p�, hout 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: $ (05i 0 0 (calculated from fee schedule) Mail In Processing Fee: $3.00 per application Total Enclosed: $ lcp O) 00 Make check payable & Mail completed application form to: Harnett County Central Permitting (HCCP) PO Box 65 Lillington, NC 27546 �, ii I Contractor's Signature: , P , • � , P 4 Date: ll 1 10 11 Q DO NOT SEND CASH. INC MPLETE PPLICATIONS WILL NOT BE PROCESSED. 10/06