SET UP •
is
Harnett Application # l o - Soo -7-5ot
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) K
Part I -Owner Information:
Home O ne Information (To be completed by owner of the manufactured home)
Name. ' 7RQ,X'1; Itle.. v i t (T) OWLS, Address: -D 0 (36w 3 5'
1 , City: A.ft A1 (' Zip: o n524 Daytime Phone: y 1 79'/0
0
7 Landow Inf r ation (T e completed by landowner, if different than above)
Name: ,.-, M \A) P JC \ Address: ,'V -Ca,' //f ,O,
%/9
City: , ?r5 4 State: AfC Zip:74 /1? Daytime Phone: (cyyr 83 ti 1c, P1-
Part II - Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, A phone must ma 'fo rmation on license)
/ A. Set -Up Contractor Company Name: /, 3".a. 22I n / 9 ' `n �^-11-
Phone: X1'2- - (2 I b t g Address: 029 /s /r1-./yAyist-h. 4/
City: A......,---.. State: 27 C. Zip: _ 2 J 3 3 ce
Setup Signature: State Lic# 3 C.
O �,ElecirIcal Contractor Company Name: - . _� Cn' _. t 'e/e vt/
Phone: ��� _b as Address: S y / if
J' City: ,� A" State: (I/ Zip: 276
0 Electrician's Signature: - 4 n 4 */ rnp„„ -- State Lic# /0
L--
C. Mec anical Contractor Company Nam - •
d Phon:: •ddress:
t City: State: "•:
H VAC Sign- • . - : 'c#
/ Plumbing > Contrac /// toor Company Name: 0-- a• _ . � S • �� . ir =
Phone: Z��� 7 73 Ad dress a�r►�ttrf -
City: 4:11O,__ State: 1 - • Z ip: 2- .
Plumber's Signature: . .S. ma . A ma r a ,fa 7 State Lic# 0
4
Part 111- Manufactured Home Information
Model Year: - ket 90 Size: /L�X 7 , # of Bedrooms, —
Park Name: lb n l e d.. AI H Lot Number: .
-) I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
.._. o information and signatures, and that the construction or installation will conform to the applicable manufactured home
r set -up requirements, and the Harnett County Zoning Ordinance. I understand that if any item is incorrect or false
inf rmation has been oroviderl-ibnt thic norrnit nnuld be revoked.
L.. i azure o H ome caner or Agent Dat
'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
Form 500 and if available, the serial number.
List of inspections and Egress requirements available upon request.
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