SET UP Application # ` r r 2 YJ
Harnett County Central Permitting
PO Box 65 Lillington, 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 part completely)
Part I —Owner Information:
Home Own Information (To be completed by owner of the manufactured home
Name: r t) t`'L Address: // c '
'K iv r✓ e ("—
City: Sev-i :A-") /rf- C _ State: Ai'c ' Zip: 2'394 Daytime Phone: (9io) 960 rH. 9 )
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Part I1 — Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, $ phon must match information on license)
A. Set -Up Contractor Company Name: 45 2 Gr/C'f'
Phone: Address:
City: State: Zip:
Setup Signature: ✓ r State Lic#
B. Electrical Contractor Company Name: 4 Odin
Phone: Address:
City: State: Zip:
Electrician's Signature: State Lic#
/
C. Mechanical Contractor o mpany Name: y 4/r/P!
Phone: Address:
City: q S : Zip:
HVAC Signature: ! L State Lic#
D. Plumbing Contractor Company Name: !I4' bwnP,,r
Phone: Address:
City: 7 State: Zip:
Plumber's Signature: r State Lic#
Part III — Manufactured Home Information
Model Year: Size: X_ Complete & follow zoning criteria sheet
Park Name: Lot Number:
I hereby certi at I have the authority to apply for this permit, that the application is correct including the contractor
information a d signatures, and hat the construction or installation will conform to the applicable manufactured home
set -up requirements, and the =rnett County Zoning Ordinance. I understand that if any item is incorrect or false
information,has been provided t this permit could be revoked.
ignature of Home Ow r or Agent D • e
'Effective July 1, 2004, a County T x De ent Movinn Permit must be provided befo 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 4/08