SET UP Application # 10 -SCO - 2S -3 K6
Hamett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910 -893 -7525 Fax 910 - 893 -2793 www.harnett.org/permits
Aoolication for Manufactured Home Set -Uo Permit
(Please fill out each part completely)
Part 1 -Owner Information:
Home Ow er Informatlon be completed by owner of the manufactured home)
Name: C Vence t r(/n t tgarn Address: 2-n- 5br-4 ! "' t ,Goad
City: G /Y /1077 State: µ ,G Zip: Daytime Phone: N g9'P9975
Landowner Information (To be completed by landowner, If different than above)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Part 11 - Contractor Information (To be completed by Contractors or Homeowner, If applicable.
Name, addre p ne must h Information on license)
A. Set -Up Contractor Company Name: or ile- n Co % ),••-•
Phone: 9/9 -77,5 ;22 7/ Address: a' en I/y / fx rte
City: ' anFork State: N,C. Zip: \ 330
.
Setuo Signature; . Etkr �, 0- 0-4, -, v State Lic# ?B-CO
B. Electrical Contractor Company Name: C 46 . fete E t / eta frt.
Phone: Address:
City: State: Zip:
Electrician's Signature; OF-4.6r C ✓ State Lic# o/. _ e ' -
C. Mechanical Contractor Company Name: ffiZiC __,State
Phone: Address:
City: State: Zip:
HVAC Signature; _ • ;l . State Licit O�i7fi1 -
D. Plumbing Contractor Company Name: Od-vvP 4' 9 v\
Phone: gf 775 0 Address: 073/ o// 1-urif
City: _5Cr n- arc (1 State: Iv ,C. Zip: 2 7.330
Plumber's Signature; IereCLv.3 l„ pr, .rr■ State Licit 1.56
Part 111 - Manufactured Home Information /
Model Year: Size: _X_ Complete & follow zoning criteria sheet
Park Name: Lot Number:
I hereby certify that I 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 Co ty Zoning Ordinance. I understand that If any Item Is Incorrect or false
info ation : a been provided t at this .: it could be revoked. f 20/
gnature of Ho e • er or Agent Date
'Effective July r, 2004, a County Tax Department Moving Permit must be provided before a Set Up Permit will be issued. It is
purchased from the fax office of the county that the home is moved from. I 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. Progress Energy customers must provide Premise Number.
SETUP
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.:� CERTIFICATE OF TITLE
(f VEHCLE'IDENTIFICATION NUMBER YEAR MODEL MAKE BODY STYLE I
I' ZN225L 1986 RIRC MH j f' '
,a. TITLE ISSUE DATE PREVIOUS TITLE NUMBER ¢ 7720611:02840174 10/13/2010 774403050752092
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v. 111I1I1111III1I11I1111II 111111■I11111II11I111I1II 111
CLARENCE EDWARD MCLEAN g '+
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L ILL INGTON NC 27546 -1876
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OWNERIS) NAME
S AND ADDRESS
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' CLARENCE EDWARD MCLEAN a
f ) ', VELMA MCLEAN.. MCLEAN
;'.95 STOCKYARD RD. ���
L. ILL INGTON NC 27546 -8044
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j a - :: The Commissioner of Motor Vehicles of the State of North Carolina hereby certifies that an application for u certificate of tide for the herein described vehicle § .r
t t S- 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 < 1 '
r `J S t : i the lawful owner Official records of the Division of Motor Vehicles reflect vehicle is suhjecl In the liens, if any, herein enumerated of the date of issuance �s! j.- •
'N ' L of this certificate. - Lk
` As WITNESS, his hand and seal of this. Division of the day and year appearing in this certificate as the title issue date.
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F LIEN RELEASED BY ''
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I n') . S SECOND LIENHOLDER: DATE OF LIEN
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1 THIRD LIENHOLDER: • DATE'OF LIEN p„
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LIEN RELEASED BY:
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-did q ADDITIONAL LIENS: 8 3 5 7 9 3 i
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