SET UP Application # / 4 ` OG 2.? /
A.
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910- 893 -7525 Fax 910- 893 -2793 www.harnett-orglpermits
Application for Manufactured Home Set -Up Permit
(Please fill out each part completely)
Part I -Owner Information:
Home Owner Information be completed by owner of the manufactured home)
Name: \---)OhOni i IY. sfh Address: 5g7o1 Co a l r RI
�'" y
City: bro '01 State: � Zip: a� 05 Daytime Phone: 71 j 1Q9 ei9e
il
Landowner Information (To be completed by landowner, if different than above)
Name: L.3o- Address:
City: State: Zip: Daytime Phone: ( )
Part II — Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, & p ne must match information on license)
A. Set -Up Contractor Company Name: f /24(4 toc1L- Chauers 1i
Phone: 775 3l9 CO Address: '2.5110 :. I P ercon -\.S 1k",
City: 5 c.St- State: P Zip: 21330
Setup Signature: ■ 4 State Lic# 3
B. Electrical Contractor Company Company e: r fl'1Ot'ri S E/t c+
Phone: "3 '787 Address: /13a 4 P LSh1'4 M 1/04L S i ie-d
City: LSn rd State: �� Zip: 01 13 30
Electrician's Sionature: Al Jl7O'12rM State Lic# /79/)? L-
C. Mechanical Contractor Company Na : 17h LShoP
Phone: 1 oQ 83 (10 Address: 3 gd4ocrCIS /
City: � . )avj4 r 1� State: Pc.- Zip: 27.330
HVAC Signature: 2i r.J"'`.-- 10 O.-46143 S 0 4 State Lic# Z3 5 i 3
n !-
D. Plumbing Contractor Company Name: c c` 6ro . PIS+ -rev
Phone: 35 ( 3 - 11 011n(o Address: 41-Ur ct.c� Cr1 &
City: c 1 4'\ -Tpra State: '< Zip: ;.2'1330 r, f
Plumber's Signature; ('.s4 State Lic# 09 �`t`I'
Part III - Manufactured Home information
p
Model Year: / ! l 7 Size: 1 ? X ! 0 Complete & follow zoning crlterla sheet
Park Name: / 8 . / 2 / , m fl P Lot Number: /77
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 County Zoning Ordinance. I understand that if any item is incorrect or false
information has en pro ded that is permit could be revoked.
Kin re of Home Owner or Agent 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. ll 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 4/08
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DAte:"' - - ' - • 7 u a p peared before me this day, each '`k , " 47 1 :, f .!..,:i-2 -:-:•,-!'!-- t , ,..,;,,,::::.•,;;-;•‘,?•..;•-1-trct3,25;,,,,t- ,--..t;•••.,
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MyCaMmIisioriexphn ' .- t - '. ' . • ' I.A ..::., -•:: ---e:---"--I--7-Telt7;e ' 1:;,9.11;')::4'6aintg ALTERATIO
NOTE: RETAIL l'URCHASER NIUSr APPIYFOR NE PURCHAS OR PAY STATUTORY PENALTY.
ERASURES WILL VOW THIS TI1 T. . E