TRADE Application # /a 0 � S ��/
Harnett County Central Permitting -,_
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910 - 893 -2793 www.harnett.org/permitst
Application for Manufactured Home Set -Up Permit ir,A.
(Please fill out each part completely)
Part I —Owner Information: 1 *. ? •" _',
Horne Owner Information (To be completed by owner of the manufactured home) , >'
Name: Kai 114 Z 17 T Address: 140 Apr LQ to , „ � .� �
City: L'II4 ten State: A/ti Zip: 2 75 ri 4 Daytime Phone: ( ) a 4fttPWlivi 1 qt
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Landowner Information (To be completed by landowner, if different than above) +c
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Name: Address: ` x `,
City: State: Zip: Daytime Phone: ( ) • t4r't`"
Part II — Contractor Information (To be completed by Contractors or Homeowner, if applicable. r " r # u!
Name, address, & phqr,e must match information on license) C1r {;
A. Set -Up Contractor Company Name: rg S 1.//dv-a,� k c n.
Phone: Address: -' `" .n
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City: Stat Zip: ' .. ,
Setup Signature: /1", /' /c (. 0
, State Lic# ' - m' f
B. Electrical Contractor Company Name: A Dirt
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Phone: Address: ,�; ,� • �
City: State: Zip: „ r 9 ^c 1, .43*
Electrician's Signature: /Z State Lic# ; i „t , '• '
C. Mechanical Contractor Company Nam /t 5 41,141 e., , 'i � 4 q ,
Phone: Address: 't 5
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City: �]7/� Stat Zip: ,<'�
HVAC Signature: 47 /7: /l State Lic# ' sJ 11 t
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D. Plumbing Contractor Company Name: 4 414 L 4 * >ti, " ' ,,
Phone: Address: 4 li i . �u 73
City: fly.-- �/g/tate: Zip: xZ VI ..r, � ;1
Plumber's Signature: Mc ( State Lic# I ' r r {
Part 111— Manufactured Home Information , * ` % :W
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Model Year: 1 y b Size: , d'� a AX 2 9 �� Complete & follow zoning criteria sheet M " ;{ P 4 ` * )
Park Name: ! Lot Number: - -rte y _,
I hereby certify that 1 have the authority to apply for this permit, that the application is correct including !he ' c ?!! c w"" "i � '' a ill;
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information and signatures, and that the construction or installation will conform to the applicable manufactuted' a 5 5 ' `
set -up requirements, and the Harnett County Zoning Ordinance. I understand that if any item is incor!ect , 9; : . 4
inf has be provided that this permit could be revoked. T'H ` f 1
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Signature of Home Owner or Agent Date r � ' ,
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`Effective July 1, 2004, a County Tax Department Moving Permit must be provided before a Set Up Permit will be it ; p,--4,40.
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purchased from the tax office of the county that the home is moved from. If the home is from a dealer, we need P . � > ��',1, > ' , , ,
Fong 500 and it available, the serial number. T YYTrff
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Pr , Ip ' . t + , t kf . : 1
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