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SETUP Application* t 4-506 3 3`-J c( 3 Harnett County Central Permitting PO Box 65 Lillington,NC 27546 Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.orgipermits Application for Manufactured Home Set-Up Permit (Please fill out each part completely) Part I-Owner Information: Home Own nforrmation(To completed by owner of the manufactured home) ('`� �' Q-C) Name: UT 1 Addre�M -\ V\ ,x.11 City: �' State:g C Zip: i ' •[)aytime Phone:( ) Lando r'Information (To be completed by landowner,if different than above) Name ���lt _ _ Address: City: State: Zip: Daytime Phone: ( ) Part II—Contractor Information (To be completed by Contractors or Homeowner,if applicable. Name,add ,8�ph m m t in rmati on license) , I A. Set-Up Contractor Company Name W ti ►'ricu'vyS Phone ,, h 3 d Address: .+ r'4C 161 3 City: 15 1 State: C Zip: 3 State Lic# '"V©0 Email: ( A B, Electrical Contractor Company Nam=; >/ *Ai IA 4S Phon:. Addres 4 ,L, �7ri City: R Ai I ` 7 i_ State: ■ Zip: State Lic# .:ISM Email: li ►r C. Mechanical Contractor Company Name:I.VEINJ1 Phone: Addres f�il. f sr'si / City:Q' State: \ Zip: Lu State Lic#? Email: r D. Plumbing Contracttor Company Name_a a ,-.. a A 4 1., I a. ... Phone:QQ� -1,15 3 )b Address _ _ r IIRRIVILID City: V State: Nrc_. Zip:• 3 State Lic# 3 © Email: N) /J 4\ Part Ill-Man Home information Model Year: 1 ∎ ize i ! b Complete&follow zoning criteria sheet Park Name: In t lX�t�-e, Lot Number: 5 I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor information and have obtained their permission to purchase these permits on their behalf, and that the construction or installa'. will conform to ;.- .• _.• manufactured home set-up requirements, and the Haman County Zoning Ordi .4..-. I u • < *if any fte 's incorrect or false information has been provided that this permit could be 4 I I —1 I Li 'gnature o'-ome Owner or Agent ate '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. If the home is from a dealer, we need proof of year on the Font SOO and it available,the serial number. List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number. SETUP 04/11 | --- - ---- -- ----------- - - 11.,,l':.'„).',„';''',,....:1'1','1'.:'''':-.':' :''''':i i,'-,-„,:i'''':4';''' •:::'''' ,:.:..''..',.;:?...,,,,,,., STATE OF NORTI1 C,./k,RO,LTA, '...0,,,...1',...,, :',..,,,,,,i,,„:?,!,,,,..:t.„,.:-..,'::„:::,,,#.,,),,,,':.:,,,:,..,..;,,!?,,(1::,;.,,,,,,,:t..,,,A,,,,,f.j.,,:,ii:::?,::::"„, ,,,,,, 1,1 !:....4:;;.,,,,!,; VEILICLE IDENTIFICATION NUMBER YEAR MODEL MAKE BODY STYLE rit, , :: : ,1 SG20018 1986 SPEC MH ,..,t,,,,11,::::41;:, tt.,,,,,:4 t TIT(F.NUMBER . TITLE ISSUE DATE PREVKIUS TITLE NUMBER i , ::„„.....,..,,. ,„:: ?II 1111111111111111111111111101111111111111111111F ; ,, ...:-.4, ,,, ,,„ tt Fhe Conmusswiner of Motor Veinclei,ot the Mate of North Carolina hereby certifies that an application for a certificate of title for the herein described vehicle 11,t,,,'',:',i',:tt:'; j'''S''',''4111,t, has been filed pursuant to the General Statutes of North Carolina and based on that application,the Division of Motor Vehicles is satisfied that the applicant ,,,t!...'llft`tt'';:ti '::,,,,i:-.1, ',,,,,t' is the lawful owner.Official records of the l)istsion of MotQf Vehicles reflect vehicle is subject to the hens,if any,herein enumerated at the date of issuance -t.t.0 tfit,,,,,,:" r,,,, , of this certificate. . . ' :41i:':41".: I J...'t.!:'',it..0 As WITNESS,his hand and seal of this Divtsion of the day arid year appearing in this ceDiticate as the title issue date, 1:,0)*'..1 NilL411 6.) ' ,t.t.'''44'' SIGNATURE ... r) L'' THIRD LIENHOLDER- DATE OF LIEN 1,- „Xi..; , , ,,. ,,,,,,, ,,F., TITLE ,;i0, 1 ,,,,..-i. i FOURTH LIE2.41OLDER, DATE OF LIEN '4: -, r4111V.4',,,,,,,',,‘;1:;Alik''.`,,,,,' , ',"r"■,.1:, ,f;', .','':,' ANY ALTERATIONS OR ERASURES yr 0,ID, TIT ,, :ay.,,,,:,,,,,,,,, , #A,,,,,:-.:4-,, j.,, ,..,,-:,,,i.:, e -,,f,,,,,,,,,,,