SET UPHarnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910- 893 -7525 Fax 910- 893 -2793 www.harnett.org /permits
Application for Manufactured Home Set -Up Permit
(Please fill out each part completely)
Part I -Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: A Intl V? ¶CtI RC..t o'' Address: )d- &4-Q0 I.Qt
City: L X ktcittjl State: Nl-- Zip: 0 S� S Daytime Phone: (7(/t CI T c 0-1,f
Landowner Informations (To be completed by landowner, if different than above)
Name: S( t. Address:
City: State: Zip: Daytime Phone:
Application 51—P,
Part II Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, Alone must match information on license)
A. Set -Up Contractor Company Name: Kai no y Araw i-�
Phone: 'lIt) 3 S to 41M 3 Address: I' to (4) II L c
City: YUu. cit.J N
cry State: Zip: al UV
Setup Signature:
t State Lic# 37/ y
B. Electrl aI C ntrac Company Name: J r� I'(J'rr. C I P F r (y,' u
Phone. l0 `I U ID S Address: /1 S hrwt. W kQJLQ O,-
City: Ann 0 l State: KJ t--_ Zip: 0 3 3 O
tQ
Electrician's Signature: p a-- State Lic# a 1 3 a U
C. Mechanical Contractor Company Name: (x4 o klln
Phone: 71 ‘1" 11 1'Y Address: 1 4 S 4 G wti TN 4,1 nci
City: S(.w..G id State: N L Zip: ai 3 3 0
HVAC Signature: 14 >r „(c State Lic# a 314
D. Plumbing Contractor Company Name: T fc(M /Q /(As h,ir
Phone: 710 53o Y Address: t A S W a i ,u2._
Cit SotA U (^r,/ State: id L- Zip: 2-. 1 S 3
Plumber's Signature: State Lic# 0 9
Part III Manufactured Home Information
Model Year: 14 2,0-(-4 9 ¥Size: 3(. X a `I Complete follow zoning criteria sheet /J
Park Name: 14 2,lttu``y' (IL i1a Lot Number: F- a5 &oct r c
I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
inform n and signatures, and that the construction or installation will conform to the applicable manufactured home
set -u. .uirements, and the amen County Zoning Ordinance. I understand t at if any item is incorrect or false
infor n has been provide that this permit cpuld be revoked. g
Signature of Home Owner or Agent Date
'Effective July 1, 2004, a County Tax Department Movino Permit must be provided before a Set Up Permit will be issued. It is
purchased from the tax office of the county that the home is moved from. If the home is from a dealer, we need proof of year on the
Form 500 and if available, the serial number.
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number.
SETUP
4/08
SEP -30 -2009 12:10P FROM:000NTRY FAIR HOMES 97757533
actors or Homeowner, II applicable.
IntMTBtlon
erentthbn,6bove)
Daytime Phone:
Zip:
State ucx
Ha
PO
Telephone Number 9t
Aoolicatbn f
(Plea
Part I —Owner Infonytatlon:
Home Owner We pion (To be competed
City.
Pad it Contractor Mniormat
(To be to
PMme,
A. Sot-Up Contractor Company Nam
City:
Setup 8$ana(ur
B. Electrical Cgntractor
Phone:
City:
FJecubfan$ Signature:
C. Mechanical Contractor Company
Phone: A
City:
tiVAC Signature;
D. Plumbing Contractor Company N
Phone:
City:
Piumber,,y Siunadue:
Pad 111 Manufactured Nome Informatics
Model Year: Size:
Park Name:
I hereby certify that I have the authority to ap
information and signatures. and that the
set requirements. and the Harnett County
information has been provided that this permit
Signature of Home Owner or Agen
'Effective Juiy 1, 2004, a Count' Tax Dnoadment Abu
purchased kom the fax Oboe pithecounty that the
Fonn 500 and if available, the serial number.
List or Inspections and Egress requirements available
SETUP
TO: 919108932793
Application a 7 U
ty Central Permitting
Li hington, NC 27546
Fax 910 893 2793 www.hernettorglpermfts
anturM Home Set -tlo Permit
each part completely)
of the manufactured home)
Address:
zip:
State LIoa
Zip:
1e� State Lich
a
follow zoning criteria sheet
Lot Number:
his permit, that the application is correct Including the contractor
or Installation will conform to the applicable manufactured home
Ordinance. I understand that if any item Is incorrect or false
revoked.
Date
oast be pwvidad beam a Set Up PemJt will be issued. It is
ham. p the home is from a dash; it, need proof ol year on the
Pmgress Energy customers must probfde PrarMse Number.
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