SET UP Application # // fc 2 /7
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 1 -Owner Information:
Home Owner Information �(To be completed by owner of the manufactureaborme)
/ tfo.
Name: 1 t 1 1 t yen flS Address: aa ' ' C t OCtC Rd
Cit Li I. I( \Sroh State: t\1C zip:° S4 oaytime Phone: NI VA - 882 9
Landowner Information (To be completed by landowner, if different than above) (���
Name: Jfl•N"-.4-b'rntCfCel TCC qa y
City: 1 �T ua\/ 1� ` State: I ` Zip: 2 - 7 S O Daytime Phone: (Q $� L t a G 02 - ( 1 4,
Part 11 — Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, addres 8p , ho ne m st matc info o licpnsg)
A. Set -Up Contractor Company Name: P/l..tA /&994 -7
Phone9& )1 ( '3&a'' Address: �!L J °� ire a- 0f /
City: cif t J�'� l� i. f State: / Zip: 3 3 4—
Setup Signature: " 1-......'4...------- State Lic# 1 Lo 0
B. Electrical Contractor .ompany lc S Ekc4 C
Phone: (i10) V13-%StS Address: Ia(o bonr,a's Lim
City: 5Prine LaKt'_ state: NC- Zip: ol$ O
Electrician's Signature; ,� ► )r»v-e-- State Lic# 01 51 O -t-1
C. Mechanical Contractor Company Name: Ti Trtrv. &fi�l,_, 1 �a aS Rd
Phone: cilq LH - S6Zlo Address: "iLtrt�lurRd
City: J3 L)G State: NC Zip: c77505
HVAC Signature: .iyn -. . 9/ 4 S_Cc- State Lic# 1 ;; r � gio
D. Plumbing Contractor ompanyName( 'c Y -S�\l nibin
Phone: gig rt o'50ZL Address: Q (�aur r `C` A
City: r 1t 1 h.X+ State: <- Zip: onS0 S
Plumber's Sianature: ,— _ _ State Lic# 1 aol�,
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Par 111- Manufactured Home a Information
Model Year: Iq O-- Size: 1 4 X 1 0 Complete & follow zoning criteria sheet
Park Name: Lot Number:
I hereby certify That I have the authority to apply for thls 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 re uirements, and the Harnett County Zoning Ordinance. I understand that if any item is incortect or false
informatio has been provide t this permit could be revoked. f
J. l ) r y
of IoII1
Si ature 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 if available, the serial number.
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number.
SETUP 4/08
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NORTH CAROLINA
BILL OF SALE
HARNETT COUNTY
THIS BILL OF SALE, made this 8th day of March, 2011, by and between Sheryl
Fogleman Kelly of Fuquay Varina, North Carolina, hereinafter called "SELLER ", for valuable
consideration paid to it by Brian W. Thomas of Lillington, North Carolina, hereinafter called
"BUYER ", receipt of which is hereby acknowledged, do grant, sell, transfer, and convey to
BUYER the personal property as follows:
1982 Oakwood VIN #210603, Hud Label #296978
SELLER warrants that it is the lawful owner of the personal property and that the said
personal property is free from all encumbrances. SELLER further warrants that it has the
authority to sell the said personal property and will warrant and defend the right against the
lawful claims and demands of all persons.
BUYER shall have all rights and title to said personal property designated above.
IN WITNESS WHEREOF, the undersigned has executed this instrument this day and
year first above written.
•
Lel (SEAL)
Sheryl Fogleman Kelly
************************ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
NORTH CAROLINA
ACKNOWLEDGEMENT
HARNETT COUNTY
I, a Notary Public of said County and State, do hereby certify that Sheryl Fogleman
Kelly, in personally appeared before me this day and acknowledged the due execution of the
foregoing instrument for the purposes therein expressed.
WITNESS my hand and notarial seal, this g day of PI , 2011.
44), APRIL M. McLAMB ��//�� �
h. NOTARY PUBLIC 1n •iQ, /14. Mry
HARNETT COU N.C. Notary Public
Nty Commissio Expires - 7 �
My Commission Expires: