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Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893.4759
Application for Manufactured Home Set-Up Permit
(Please fill out each Part completely)
Part I -Owner Information:
Home er 00M To be completed by owner of the manuf ctured home)
Name: Address: S71 aaye-_w Sclrcr l rYP.
'If
City: <,-11~Lj_ State: N C - Zip: DIE)- Daytime Phone:
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Part II - Contractor Information (To be corn I0te, y Contractors Homeowner, if applicable)
A. Set-Up C tract r ompany Name: t &A Al I State Lic#
Phone: l~ 5 3 94 Ad ress:
City: e: fl: Zip: -7 :3 L
Sionature:
B. Electrical Contr ct ompa e: late Lic#J J 335- U
Phone: 71-5-1 QvI Address:
City: State: AIL Zip: 1273312
Sianature:
C. Mach? ' IC ntractor Company Name: State Lic#
Phone: 9f % y Address:
City: 4,y,L~ State: c Zip:
Sianature:
D. Plumbing Contractor Company Name: 5 6x State Lic# 8rj S
Phone: -77 - 3 Address:
City: tate: 4Y C. ip: ,77, 72,
Sianature:
Part III - Manufactured Home Information
_New _,hetlsed
VSinglewide _Doublewide _Triplewide
Model Year: Size: 4 X~D
__zPrivate Property Manufactured Home Park
Park Name: Lot Number:
Directions to site or Manufactured Home P rk from Lillington: - Wej f- ox
zQgt r e
R-4ft.4g W"
,2 -0
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
revokst
/ldY.rl~/rut C °d lv' 30- O (o
Signature o wner r gent Date
'Effective July 1, 2004, a Harnett County Tax Depart r Moving Permit m t be purchased before a Set Up Permit will be issued.
06/04
I
Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-4759
Certification of Work Performed
By Owner/Contractor
Owner (s) of Structure: 'Do K41 ti C R~/JS
Owner (s) Telephone: !?Z !!j q,? t,*- S7 S 5'
Owner (s) Mailing Address: 5/ / QA Q Ire SG bb/_
S=i6r-id C- 2233.1-
Construction or Site Address c e
Sa: / , 2Z 3z-Z
Job Cost:
Directions to Job:
a eh t i ~Q
rlt C Rethailew
emhaizea s- of" I, "/Z-- D e_
Subdivision: /1 Lot
I OP1,7,~d ~it.phf have provided or will provide the
o(Name)
r labor on this structure. I am the owner or hold a NC
(Trad )
state _ license number 44PLtF,.j which entitles me
(Trade)
to perform such work on the above structure legally. All work shall comply with
the State Building Code and all other applicable State & local laws, ordinances
and regulations. /
Owner (s) signature: ► Date: 06
Contractor's Name: Date: 6- 3o-67&
Address:
County:
Contractor's License:
Contractor's Signature:
08/04
Application #
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number 910-893-4759
Certification of Work Performed
By Owner/Contractor
Owner (s) of Structure: L~
Owner (s) Telephone: 9/9
Owner (s) Mailing Address: /,-CI) ~C~~a~ /Paces/
X3'-2-/706
Construction or Site Address:
Job Cost:
Directions to Job:
Subdivision: Lot
hT t s Sei~~e 0~e provided or will provide the
/ (Name)
..~1 cc b labor on this structure. I am the owner or hold a NC
(Trad,e)/
state 1 !v ~ license number' 6? which entitles me
(Trade)
to perform such work on the above structure legally. All work shall comply with
the State Building Code and all other applicable State & local laws, ordinances
and regulations.
~tuK.~ o Date:
Owner (s) signature: -l7 d l
Contractor's Name: f Date:
I W4
Address: C- h
County: q
Contractor's License: -
Contractor's Signature:
08104
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