SET UP Application # 0 2 4 5 //
Harnett 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: Pine Grove Development Cor$ddress: Buffalo Lake Rd.
City: Sanford State: NC Zip27332 Daytime Phone: ( )919-499-184j
Landowner Information (To be completed by landowner, if different than above)
Name: 54m Address: GA IA n ch l n � l YGI
City: C,tl y1Q rt h State: PL Zip: ZF-5Z (v Daytime Phone: ( ) 1 ticR I 1
Part II - Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, & phone must match information on license)
A. Set -Up Contractor Company Name: Marks MH Setup
Phone:9 499 -2768 Address: Black Rd.
City: Camerob �� " �" State: NC Zip: 2 8326
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Setup Signature: d,R.ri/I (G6t,/v State Lic# 3441
B. Electrical Contractor Company Name: GEB Electric
Phone:919- 499 -6013 Address: Altons Lane
City: Sanford State: NC Zip .27330
Electrician's Si nature: State Lic# 17758 -L
C. Mechanical Contractor Company Name: Murphy' s Heating & Air
Phone: 919-776-532 Address: Sloop Court
City: Sanford State: NC Zip :27332
HVAC Signature: $, P,t'.LN I AA, State Lic# 1 5020
D. Plumbing Contractor Company Name: vant Enterprises
Phone: 910- 843 -5400 Address: P.O. Box 130
City: Lumber Brid• / - ate: NC Zip:28357
Plumber's Signature /'lone, /A'f'/ State Lic# 1 1 54 2
Part III - Manufactured Home Information
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Model Year:c () 1 b Size: 71, X20.0 II Complete & follow zoning criteria sheet
Subdivision: /
Park Name: Nature' q Crncarnads Lot Number: lP
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 that if any item is incorrect or false
in •rmation has been provid - • that this •ermit could be revoked.
! l /// ./ I VII lg /�lo / 0
/ Signature of Home Owner or Agent Dat
July 1, 2004, a County Tax Department Moving 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
4ine Cro
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Velopment C oto
Date: June 17, 2010
Lot # - 60 Subdivision - Nature's Crossroads
I certify that the Manufactured Home for Application # 10- 50024511 is a 2010
Champion Model.
Pine Grove Development Corp.
By: James D. Stovall
I /ma° ndAoc--e040
622 Buffalo Lake Road, Suite A • Sanford, North Carolina 27332 • (919) 499 -1841 • Fax: (919) 499 -1888