SETUP
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Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-4759
Application for Manufactured Home Set-Up Permit
Please fill in each part completely:
Part I - Home Owner Information (To be completed by owner of the manufactured home)
Name: Pine Grove Development Coro Address: 622 Buffalo Lake Rd.
City: Sanford State: NC Zip: 27332 Daytime Phone: ( 919) 498-2204
Landowner Information (To be completed by landowner, if different than above)
Name: -6a n? G ce$ 0.110 ye- Address: q5 38', f I0t r /e YyQ Lt?.
City: -State: Zip: 28321. Daytime Phone: ( ) in rom Part II -Contractor Information (To be completed by Contractors or Homeowner, if applicable)
A. Set-Up Contractor Company Name: BRANDON'S SET-UP State Lic# 2788
Phone # 919-499-6870 Address: 46 Bargain Lane
City: Sanfo ~<_~Stat_NC Zip: 27332
Sigrar.~re; 1~z~i
B. Electrical Contractor Company Name: G.E.B. ELECTRIC State Lic# 17758-L
Phone # 919-499-6013 Address: 431 Altons Lane
City: Sanfor fate: NC Zip: 27330
Signature: Z
C. Mechanical Contracto any Name: MURPHY 1-1 EATING A, AIR State Lic# 15020
Phone #_919-776-5324 Address: 209 Sloop Court
City: Sanford State-: ~NC -Zip: 27330
Signature: ~o I/e
D. Plumbing Contractor Company Name: Philroan State Lid 11542
Phone # 910-843-5400 Address: P.O. Box 130
City: Lumber Bridge S te: NC Zip: 28357
Signature. _
PartIII - Manufactured Home Information / ~
w' New or -Used Model Year No Size: % X /
_Singlewide ✓ Doublwide Triplewide
-Private Property
~ Manufac~yre HmnetPark
~1~PerckName: JY~} IGS ~{~(~S6YOGLls Lot Number. Y~
Directions to site or Manufactured Home Park from Lillington:
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hereby certify that I have the authority to apply for this permit, that the application is correct including the
contractor information and signatures, and that the construction or installation will conform to the
applicable manufactured home set-up requirements, and the Harnett County Zoning Ordinance. 1
understand that if any item is incorrect or false information has been provided that this permit could be
revoked. C
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Signature of Owner or A n Date
02/01
41ne Gr
~~elopment Co~4
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Date: June 8, 2006
Memo to: Harnett County Central Permitting
From: Pine Grove Development Corp.
RE: Lot # 42, Nature's Crossroads, Harnett County, NC
Application # 06-500-14997
We certify that the manufactured home to be place on the above noted lot is a 2006
model Champion home.
James D. Stovall
Construction Manager - PGDC
I
622 Buffalo Lake Road, Suite A • Sanford, North Carolina 27330 (919) 499-1841 Fax: (919) 499-1888