DOCUMENTS Application# 4 i aS
Harnett County Central Permitting
PO Box 65 Lillinglon, 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 pan completely)
Part I-Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name:Qke(n' de- �yLrre? &ti 4ddress: I ell F\teny(nT l� Lr
City: �%(•.n10Y� State: NC Zip: `�133� Daytime Phone: ( �g161 JqS- 3
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Part II-Contractor Information(To be completed by Contractors or Homeowner, if applicable.
Name,addresg3gSi phone ustm� atch information on license)
A. Set-Up Contractor Company Name:1/44 4GCC H1H ENCJ4e_V'S
Phone:PR-1193(0(t Address: m335
City: 'w1wd State: K c Zip: a73'32_
State Lic# 31.10 0 Email: ntA
B. Electrical Contractor Company Name(Y'xd\ n )u7 x t-C K 'LJc1,(Ca
Phon . 1D"1��C Address: 3CCD F MC11n �t
City: YCie-e^ State: Zip: a
State Lic# a3�`( IO Email:
�} ` TTt11111
C. Mechanical Contractor Com any Name: t Lfl NY)
Phone:G11I ':0S- 3LfDAddress: 3L cD t, ornj
yzg
City: St \rc.-t State: I `v C , Zip:
State Lic# ass1/Yj 3 Email: 1\)/�A I '
D. Plumbing Contractor Company Name:{�psQet POCK1ltk r1V Q V S
Phone::ClYla•11%�.',.Sto0U Address: ,3 35 KC—{1x/
lu
City: 6.f sC-0 f /I State: h/ C Zip: )
State Lic# 31A0 O Email: PC) I 4\
Part III-Manufactured Home information
Model Year: 1901 p Size:M XI�C Complete& follow zoning criteria sheet
Park Name: Y1' iva f € Let- 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 have obtained their permission to purchase these permits on their behalf, and that the construction or
installation will conform to the applicable manufactured home set-up requirements, and the Harnett County Zoning
Ordipaice. I understand that if any item is incorrect or false information has been provided that this permit could be
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Signature of HomeOwner 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 Progress Energy customers must provide Premise Number.
SETUP 04/11
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HARNETT COUNTY CENTRAL PERMITTING
P.O . BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Application Number 17-50041125 Date 5/04/17
Property Address 287 SABASTIAN LN
PARCEL NUMBER 09-9566- - -0082- - -
Application type description CP MANUFACTURED HOME RA20R/RA2OM CRITERI
Subdivision Name
Property Zoning PENDING
Owner Contractor
PATTERSON CLYDE & MOSS OAK RAVEN ROCK MOBILE HOME MOVER
INVESTMENTS LLC 3335 NC 87 HWY.
4271 LEAFLET CHURCH RD SANFORD NC 27332
BROADWAY NC 27505 (919) 775-3600
Applicant
MARTINEZ-GONZALEZ BRENDA
167 FIRE THORN LN
SANFORD NC 27332
(252) 360-7384
-- - Structure Information 000 000 14X70 SWMH 4BDR 8X8 DECK ALRDY BLT
Flood Zone FLOOD ZONE X
Other struct info # BEDROOMS 4 . 00
MOBILE HOME YEAR 1996 . 00
PROPOSED USE SFD
SEPTIC - EXISTING? NEW
WATER SUPPLY COUNTY
Permit LAND USE PERMIT
Additional desc
Phone Access Code 1189802
Issue Date . . . 5/04/17 Valuation . . . . 0
Expiration Date . 10/31/17
Permit MANFACTURED HOME PERMIT
Additional desc .
Phone Access Code 1189810
Issue Date . . . 5/04/17 Valuation . . . . 0
Expiration Date . 5/04/18
Special Notes and Comments
T/S : 04/07/2017 12 :44 PM LBENNETT
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 17-50041125 Date 5/04/17
Property Address 287 SABASTIAN LN
PARCEL NUMBER 09-9566- - -0082- - -
Application description . . CP MANUFACTURED HOME RA20R/RA20M CRITERI
Subdivision Name
Property Zoning PENDING
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . MANFACTURED HOME PERMIT
10 501 T501 R*MOBILE HOME FOUND. / M. WALL / /
10 814 A814 ADDRESS CONFIRMATION / /
20 818 Z818 PZ*ZONING INSPECTION / /
30 507 T507 R*MANUFACTURED HOME FINAL / /
999 H824 ENVIR. OPERATIONS PERMIT / /