DOCUMENTS • Application# ID l W"t`tN
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.hamett.org/permits
Application for Manufactured Home Set-Uo Permit
(Please fill out each part completely)
Part I-Owner Information:
Home Owner•y� Information(To be completed by owner of the manufactured home)
Name:firm A4n4‘ m.jInr Address: ed. 3ca( 3352
City: Lf 1/11'I-on State: AI/_ Zip: a-754(O Daytime Phone:10 flJ _.(SaQ-
• Landowner Information(To be completed by landowner,if different than above)
Name:to„n-k.n.1 tar Address: Ptd Raz 025B
City:u;ftIv1S/I State:'NO rip: 27$4Dayume Phone:(36 $32 ( SQ.�
Part II-Contractor Information (To be completed by Contractors or Homeowner,if applicable.
Name,address,A$phone must match Information on license)
A. Set-Up Contractor Company Name: -C.arn l,„s C.o..SF"'c4'— f< 'P1°S1ae l/ej^-
Phone:.G/D -G5!-7.714 Address: 42/ 0// /,5 '4.34 S
City: al)InQ4n., ��lgSttate: /C Zip: a754/o
State Llc# 1 1D IElnail
B. Electrical Contractor Company Npme: Pan^dX r Fin 4Mr.
Phone: 9/n- Q 14' 'ap4'7 Address: !Vv.)11 Thonna.s
City: L;(I: j4er State: At Zip: '» S4
State Lid/ Li
7/ 1 Sia. Email: �/t
C. Mechanical Contractor Company Name:_ 5 lr /" l •' -....» _ 1,.,u,,, - -
cJ ���n1 y. q`r-
PhenoPhenel/ Z91 3Svkddress: 7�.4- art, / /;•�l(,r{dn= 4 CA
City:
l
I e n✓\ State: AK, ap: _r" U a-"7 5 4
State uc# 5 14} i L )=mail:
D. Plumbing Contractor Company Name: 4 I(b 3 -Pktav 1.in
Phone: 919 -'9(ol4 "229'7 Address: fl2/ W Ra/m) rt Si!•
City: 4..Pnvtr State: Ai( Zip: e')fPfD'1
State Licit (L aL 2 / Email:
Part III-Manufactured Home Information
Model Year: l gig( Size: LLX OS Complete&follow zoning criteria sheet
Park Name: N/A Lot Number: Milk
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
Ordinance. I understand that If any Item Is Incorrect or false Information has been provided that this perms could be
revoke
6- QO - /2'
SIgnatum of Home Owner or Agent Date
`Effective July 1,2004,a County Tax Department MoWna 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