SET UP tr,,4
Application # 10 ,SoO / ge , � _
Harnett County Central Permitti ,t
PO Box 65 Ullindton, NC 27546 ya
Telephone Number: 910- 893 -7525 Fax 910- 893 -2793 www.harnett.org /permits
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Application for Manufactured Home Set -Up Permit e , ,?,10 - ,t. , I
(Please fill out each pan completely)
Part I -Owner Information: ;#
Home Owner Information (To be completed by owner of the manufactured home) , *.
Name: Th. • e// hie9c1,,vd Address: /5'S t.On /lre /Y)ksa, 4v. --;y, •.
• City: Sgn %af L State: tie Zip: aJ Daytime Phone: (9/4 308 - �-1/ 3 $ -,�, t o
f Landowner Information (To be completed by landowner, if different than above) k
";y r a
Name: Address: .,-
City : State: Zip: Daytime Phone: ( ) y
Part 11 - Contractor Information (To be completed by Contractors or Homeowner, if applicable. ° �r !..11 `
Name, address, 8 one myst mach mf rmation on license) �' ' " µ
4 Set -Up Contractor Company Name: � 4 TQ i>a '
p ,
4 I ' z '4. 50.4
10 1,1:1/2!;
p 1 i t' -1 �o ,G� Address: ,Q q1 / 5 70 � R cQ �n,'
City: Sate.-- State: ) t - Zip: 2 3 ; - . ,-/ ;s
Setup Signature: a,7.-.•-•//5 State Lic# 3 D 24 �.--. '
B. Electrical Contractor Company Na( �� ``tt .r t
T x , o - y 8ti
Phone: Address: y , ` p� :
Alt r n 1
City: State: /� � Zip: ; Ti w • .d
Electrician's Signature: i / State Lic' / �/— : ;et e v :']]
C. Mechanical Contractor Com n N If � r ' ii / 'i i s t 'c 3 % ' S ' n p
Pay � ! x'i -ti k
Phone: 9�o 4 (p ' Address: —/ILarri M! ,: . ` ['MA ;
� " �r.
City: - id, .._ . ' State: i .. Zip: ,� s3 i �c •4.k xs.
HVAC Sgnature: A ! - -+� State Lic# -, %% • ` � r 1
: '
/I 1: a Ca ll
D. Plumbing • • ' ompan ame: A s yarn C/ er ;tall a+ r :*,b,1
Phone: Address: i' I{ ,}04;,04 r 4 P',
u
City: St Zip: s t ,t. ;: . :
2 _
Plumber's Signature: � `�� State Lic# x 1 1 , J
i • $ . rdl ,, tY
Part 111 - Manufactured Home Information ,e-2 vi „,-„, # i/ P/VC 9 i j
Model Year: /99,5 Size: ,-))8 X 2 a , Complete & follow zoning criteria sheet , q
7�r t $. ,
Park Name: Lot Number: - �)"0.5 ;, r
I hereby certify that'I have the authority to apply for this permit, that the application is,correct including the e + ,
Information and si natures,.and that the construction or installation will conform to the applicable manufactur4 r ' ` ,,, I
set -up requiremena and.the Harnett County Zoning Ordinance. I understand that if any item Is Inc-Prraof?r 4t , f i t z,
information has been provided that this permit could be revoked. n + int
Signature of Hoy Owner or Agent Dat6 a 4
'Effective July 1, 2004, a County Tax Department Moving Permit must be provided before a Set Up Permit will be ,sa S , ! r
purchased from the tax office of he county that the home is moved from. If the home is from a dealer, we need ProPT l `1� + , r
Form 500 and if available, the serial number.
List of inspections 1'
mlee t " �8 `
pecdons and Egress requirements available upon request Progress Energy customers must provide Pre x,
SETUP `ir
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Application # 7
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910 -893 -7525 Fax 910 -893 -2793 www.harnett.org /permits
Application for Manufactured Home Set -Up Permit
(Please fill out each part completely)
Part I -Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: Address:
City: State: Zip: Daytime Phone: ( ) /Z
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Part 11 - Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, & ph a mu At match information on license) � 7e3 53
A. Set -Up Contractor Company Name: c An O-✓dj$ `r/
Phone: 70- f3 -/6 1(o Address: 99 3 ,3 /a.et.n . 2 d
City: n u-AJn) State: AJ. G, Zip: O 33 Y ?
Setup Signature: ctnivnes /3n 4 J $ State Lic# On?
8. • Electrical Contractor Company Name:
Phone: Address:
City: State: Zip:
Electrician's Signature: State Lic#
C. Mechanical Contractor Company Name:
Phone: Address:
City: State: Zip:
HVAC Signature: State Lic#
D. Plumbing Contractor Company Name:
Phone: Address:
City: State: Zip:
Plumber's Signature: State Lic#
Part III - Manufactured Home Information
Model Year: Size: X # of Bedrooms
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 County Zoning Ordinance. I understand that if any item is incorrect or false
Information has been provided that this permit could be revoked.
Signature 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. 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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