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SET UP Application # , . 24 / 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 -Up Permit (Please fill out each part completely) Part 1 —Owner Information: Home Corner Information (To be completed by owner of the manufactured home) Name: liQC \iQ Ina r$tS Address City:` an, trio n State: I4.(' Zip: am. Daytime Phone: (90) 6 90 - Gt'(( Landowner Information (To be completed by landowner, if different than -\(? above) `' Name: �rO C • mQh Address: ¶5G? alai r ks a . City: CD rnP inn State: J'1 • C. Zip: c2. ¶%4,, Daytime Phone: (9 /6) a Y5- 9( a a Part 11 — Contractor Information (To be completed by Contractors or Homeowner, if applicable. Name, address, A pho, em must match information on license) A. Set -Up Contractor Company Name: /1 j U • /Iv Phone: Address: City: tate: Zip: Email: • Setup Signatur- A 4 L e. ' • , � • SA A ∎ . - -SIP State Lic# r B. Electrical Cont actor Company Name: A 5 da7sr Phone: Address: City: State: Zip: 1 Email: Electrician's Signature! _ • L.) •. 41 w 0 LA LLros State Lic# C. Mechanical Contractor Company Na Ili Phone: Address: City: St- e: Zip: Email: • HVAC Signature: A 1116. e. i \ tee. Ua1 g i M. tate Lic# D. Plumbing Contr. ctor Company II ame: ,f') . /7id.iti_ Phone: Address: City: State: Zip: Email: • Plumber's Si. nature 4 k %, , .. e _ Ihs• _ lama State Lic# • Part 111— Manufactured Home Information Model Year: Ta f or 0 S ize: h1 x (e7 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 information has been provided that this permit could be revoked. .. a 1A... --...... 3 - 9- 1( ‘ 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 if available, the serial number. List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number. Mobile Home Setup Application 1 of 1 12/10 r. tv $" N v p o o g � . , ° •� d � a � z y �YA7� ' ILL Iva re I i :Hui n I LT 54 L J.- CRf6/p�� r-4 N \ *o R i t. t F a W +^i ' ` ria J Q z ' r r . i� � ; U © w It�A -,61:7,..".:.c.,;22; r a 3 k :,,,."-Y4 :t .' . ' ; '-!{.4` } � Z LL M' p � p i - 5 ,? g t ,t {� .Q i ti ' W Q ? �)Y g I ' p. fW t y 1 vFt g ;` i 2 . V ] rt v0 � l j :� r i ry i 2 to Q : <^. Ill i, ?. V7 fi '` �Z w ma `�0 ".m k � . k' ` 1— p m. Q t 1 � p, � W 3 � w z A C! � � N m m z ,`< m,x:m tN iW4 4 N ci g0 21 J W Q J 2 lL Q O N1 J2 - uJ2 w co co !' hi m N 'CW�04 14110 QY o t�z ��� -yii f++•. 3! �NG,J , �4NU Bb .H • - ,. •.° ., K7 €,�3'�I�iAtLYfA�. € ?�tibrof[i €3