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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)
j Name: Pine Grove Development Corp 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: 2 Q-% G VG Address: n65 zrj t3trCl brl ye,
City:- Q InAd Mrs State: ru L Zip: zf(X&u Daytime Phone: ( )
Part Il - 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 # 919499-6870 Address: 46 Bargain Lane
city;. J Sanfo Stat : NC Zip: 27332
Signal ~rw; t
B. Electrical Contractor Company Name: G.E.B. ELECTRIC State Lic# 17758-L
Phone # 919-499-6013 Address: 431 Allons Lane
City: Sanfor tate: NC Zip: 27330
Signature: atb~ Glq -
C. Mechanical Contractor Csompany Name: MURPHY HEATING & AIR State Lic# 15020
Phone 14_919-776-5324 Address: 209 Sloop Court
City: Sanford State: NC Zip: 27330
Signature: C 6 r, 6uz 4r
D. Plumbing Contractor Company Name: Phil Bryan([ State Lic# 11542
Phone # 910-843-5400 Address: P.O. Box 130
City: Lumber ride St te: NC Zip: 28357
Signature. -
Part 11- Manufactured Home Information
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New or Used Model Year L)(. Size:76 'X $0 y
_Sitiglewide 6/Doublwide Triplewide
-Private Property
-Manufactured Fiome Park, y
-5DharlrName: PL(a~tnvtt3 C r056 roc; A s Lot Number: -
Directions I
Directions to site or Manufactured Home Park from Lillington:
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LAU r~ er Iv'a+ -Turn nP on-Fe
t d 81 r-d Dri de - L o f 40 i s On
I 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. I
understand at if any item is incorrect or false 'nfornation has been provided that this permit could be
revoked. V 8 l7
Signature of Owner or Agent Date
02/01
I
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~~~/opment Co~Q
Date: June 8, 2006
Memo to: Harnett County Central Permitting
From: Pine Grove Development Corp.
RE: Lot # 40, Nature's Crossroads, Harnett County, NC
Application # 06-500-14998
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
622 Buffalo Lake Road, Suite A • Sanford, North Carolina 27330 (919) 499-1841 Fax: (919) 499-1888