setup/ permit / receipt Application#__
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.org/permlls
Application for Manufactured Homo Set-Up Permit
(Please Illi out each part completely)
Part I-Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: CV
Cle. Petit-wK _ Address:
City: Slate: Zip: Daytime Phone:( )
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: _Slate: Zip:_ Daytime Phone:( )
Pan II-Contractor Information(To bo completed by Contractors or .Homeowner.If applicable.
Name.addresa„gp Ei¢mu' Cif�h No aion n„ ne f5
A. Set-Up Contractor Company Name' x hone !-':lice
PhonecP-1,S,; ) - Address: L % IF
y,'7i'
`
City: ke- 11‘3(-vdt State: ( . Zip: cgl%
Slate Lica -L{(lC) Entail: r � IVB_
r�
B. Electrical Contractor Company Name: ilvi-AI 5 i-v6v-r'/>: L("IV
Phone: 01 Iat LCI tt 3I /b Address; j4j7 /j re..-- R CI
City: Sbyrirn—ri state.-.NC— Zip: ail 3D-
State Licit 93a{6.?- Entail:
C. Mechanical Contractor Company Namn;
(Z
Phonegi.t) Address:314
841 Fit Pr,
City: Stale:Kx Zi
_
Slate Licit5/ Email:_.
D. Plumbing Contractor Company Name:
Phone: Address:_
City: Slate:
-.-__ Zip:
Stale Lic#__— Email.
Part Ill-Manufactured Home Information
Model Year: I(7y 3 Size: lJ x 50 Complete& follow zoning criteria sheet
Park Name: Lot Number.
I hereby certify that I have the authority to apply lot this permit, that the application is correct including the contractor
informs 1n and have obtained theft permission to purchase these permits on their behalf, and that the construction or
install, will con , : the applicable manufactured home set-up requirements, and the Harnett County Zoning
Ortlii : e . I und: stand al incorre.cl or false information has been provided t .t this permit could be
evoIP I$mature i Home O -r'or Ag: Il sate
'Effective July 1,2004,a County Tax Devarjneiij 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 i/available, the serial number.
List of inspections and Egress requirements available upon request Progress Energy customers must provide Premise Number.
SETUP
04111
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Application Number 18-50043593 Date 3/27/18
Property Address 19761 NC 27 W
PARCEL NUMBER 09-9565- - -0203- - -
Application type description CP MANUFACTURED HOMES
Subdivision Name
Property Zoning PENDING
Owner Contractor
MANGUM DOUGLAS WAYNE & RAVEN ROCK MOBILE HOME MOVER
PATTERSON CLYDE L 3335 NC 87 HWY.
4271 LEAFLET CHURCH ROAD SANFORD NC 27332
BROADWAY NC 27505 (919) 775-3600
--- Structure Information 000 000 14X76 3BD SWMH
Flood Zone FLOOD ZONE X
Other struct info # BATHS 2
# BEDROOMS 3 . 00
MOBILE HOME YEAR 1994 . 00
PROPOSED USE SWMH
SEPTIC - EXISTING? EXISTING
WATER SUPPLY COUNTY
Permit LAND USE PERMIT
Additional desc .
Phone Access Code 1235894
Issue Date . . . 3/27/18 Valuation . . . . 0
Expiration Date . 9/23/18
Permit MANFACTURED HOME PERMIT
Additional desc .
Phone Access Code 1235878
Issue Date . . . 3/27/18 Valuation . . . . 0
Expiration Date . 3/27/19
Special Notes and Comments
T/S : 03/19/2018 03 : 31 PM BPETRICH --
19761 NC 27W CAMERON 28326
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Page 2
Application Number 18-50043593 Date 3/27/18
Property Address 19761 NC 27 W
PARCEL NUMBER . 09-9565- - -0203- - -
Application description . . CP MANUFACTURED HOMES
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 / /_
HARNETT COUNTY CASH RECEIPTS
*** CUSTOMER RECEIPT ***
Uper: JBROCK Type: CP Drawer: 1
Date: 3/27/18 52 Receipt no: 299809
Year Number Amount
2018 50043593
19761 NC 27 W
CAMERON, NC 28326
Bl BP - PERMIT FEES
$175.00
SWMH
CLDE PATTERSON
Tender detail
CK CHECK PAYMEN 4427 $175.00
total tendered $175.00
Total payment $175.00
Trans date: 3/27/18 Time: 14:41:15
** THANK YOU FOR YOUR PAYMENT **