SET UP Appliceton# Co n'' 24/97
Harnett County Central Permitting
PO Box 65 Ullington, NC 27546
Telephone Number: 910 - 893 -7525 Fax 910 -893 -2793 www.hamett.org/permits
Agolicatbn for Manufactured Home SetUD Permit
(Please fill out each part completely)
Part I -Owner Information:
Home Owner information (To be completed by owner of the ma home) f
Name t l(" '£l Address: '4AT 1 Sau 1s`r''t A-�e f --ociA
City: R. C1 1 ° � -13 State: WC; ztp9 Daytime Phone: Oil 931- 5 937
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Part II - Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, & one must ma i f on license
A. Set -Up C Com pny Mr.S fA sts m OUP
Phone: I (U -f
u A f Address: 2915 N. Sprit BrArcJV Rd.
cit D ann. State: N C. zip: g33
setup Signatur t J '//j � � State Licit 3 07 6
B. Electrical Contractor Company Name: L' �f4RCN'5 C' 7t4c-
Phone: 9/9- at' 9 1-
'9 1- Z Address:n l At-
city: ti State: C- Zip: 7Sa -6
Electrician's Signature; � � / e .` .r State Uc# a /jot - GC-
C. Mechaniilfcal Contractor Company Name: }
Phone: 19-5510-11(39 Address: mQfl n. m 4.AA.i CCL 1
City: Lv G state: i � , zip: 2- t+9
HVAC Signature: - L.vt r L �ny 1 - 2 �!! state La 55 3 '+7
D. Plumbing Contractor Company me: ` ? \o d t PI WYlhirc 1i .
Pho =:Q�a - �1 -(&3a Address: tl . l pat
l
City. f' f � state: NC. Zip: c�-1( �'���'�t�2�f�'
•
Plumber's Signature; /.t►» �.�c.:.<_ —4 State Lic#!�
Part III - Manuf Home In / forma a tion
Model Year: 1 f / Size° " X "✓f Complete & follow zoning crlterla sheet
Park Name: Lot Number:
(hereby certify that 1 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
information has been provided that Os permit could be revoked.
Fl2J 4 5 6-30 6
S nature of Home Owner or Agent Date
'Effective July 1, 2004, a County Taxgfoartmfl b cat Pertnft 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. 11 the home is from a dealer, we need proof of year on the
Form 500 and it available, the serial number.
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