SETUP 9108932703 Harnett County Planning HARNETT CO. PLANNING SERVICES 02 31:52 p. in. 07 -20 -2010 i it
Application # / 0 S 0 o 2 '- I-15 E
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 -Uo Permit
(Please fill out each part completely)
Part 1 -Owner Information:
Horne Owner Infor ation co be compietted by owner of the manufactured ho n /�
Name: /Nee heie4IOU° Address: *at* /Ond�o1 ige rL
City: 50434 n/,? State: AC Zip: 7:7 13 D ytime Phone: ( 1(9 35 3 d T z 2-
Landowner Information (To be completed by landowner, if different than above)) /1 /_
Name: be A ill c KA7 Address: 3 5 5 'CH'4 f "2
City: 5 State/ Zip:2 Daytime Phone: ( qty. 3 52 - 68
Part 11 - Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, & ph n m list match information on 1' e
A. Set -Up Contractor Company Name: gall T44-#1' A7n �(N*-S
Phone:9 / 770 9640 Address: God- ,�_ - e_
City: �A++ritt State: /i/C..— Zip: 273313 _ _
setup Signature: t _ e i Sttatee 2 3 If 7
B. Electrical Contractor Company Name: T - 9 4 CS (t / c/ic2c_ _
Phone:/ Y 2$ Z$ Address: 53 3 Q�lr> �grJ�l✓ /12, /cp
City: <094 e )tate,- // Zip: 27 33 2 J
Electrician's Signature: i/[tk.• State Lic# "5 4j L
C. Mechanical Contractor Company Name: J Prak..0 • y f 41
-7
Phone: 94 7)0 3 240 Address: / 6 2/ S 't i -Ai; _ 0
City: - 144/7.44G State: ?/ zip: 7 3 L
HVAC Signature; M _ State Lic 2.0r7
D. Plumbin Contractor Company Name: �• t OA ,e( �lq h 9 �
Phone: W/9 770 6 o 7 3 Address: S 112-1 Sw.t•I1 .15 47 ( 414.0 �r��4u>
City: .Yid tate: /VC-- Zip: 273 "2--
Plumber's Signature: -- ( 7... Lic# / _ 1 1 f
Part III - Manufacture Home Information v
Model Year:' !p/ ct'� 613-Y—
' Size: J �X 0 6 # of Bedrooms /�
Park Name: / � /�' Lot Number: 2 S / ` 5— /� " �Tr*sr' ill(
594F - mX we- 27.331 --
I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
information and ignatures, ;ad that the construction or installation will conform to the applicable manufactured home
set - up requir: f nts, an• Harnett County Zo :. .. I understand that if any item is incorrect or false
info atlo bee -. at this perm) • . d be revoked.
/. �/ /z/ 0
re Signa r'!-.m::�'� - -- Date
'Effective 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. 11 the home is from a dealer, we need proof of year on the
Fonn 500 and if available, the serial number.
List of inspections and Egress requirements available upon request.
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