SET UP Application # 1 / 3 727 Z6 X0 6 ��)
•
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910 - 893 -7525 Fax 910 - 893 -2793 www.harnett.org/permits
Aoolicatlon for Manufactured Home Set-lb Permit
Part I -Owner Information: (Please fill out each part completely)
Home O r Informal (To OS be completed by owner of the manufactured home)
Name: nut( ti I Address: 5 .5 kePrix Dr
City: R 1 4 - - VO4-‘ vt State: tic Zip: 0 Daytime Phone: 9/7 5 - 0 - 7 J'2y
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, address, & phone must match information on license)
A. Set -Up Contractor Company Name: As !/rst,nv,
Phone: Address:
City: State: Zip:
Setup Sianature; 79.-.... -CJc .-,��' State Lic#
B. Electrical Contractor Company Name: 4 q,1-
Phone: Address:
City: �_ State: Zip:
Electrician's Sianature; `T2 -..Rr., State Lic#
C. Mechanical Contractor Company Name: ddffzr-
Phone: Address:
City: 47 State: Zip:
.
HVAC Sianature: Pl..x.. Cam—" State Lic#
D. Plumbing Contractor Company Name: Af d /t (r
Phone: Address:
Cfty: State: Zip:
Plumber's Sianature;,] -",c f (Tt State Lic#
Part III - Manufactured Home Information
Model Year: Size: X__ Complete & follow zoning criteria sheet
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
int Lion has been provided that this permit could be revoked.
69 a_cti,.._.
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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 it available, the serial number.
List of inspections and Egress requirements available upon request Progress Energy customers must provide Premise Number.
SETUP
4/08