SET UP Application # 11 5-967
" -O 2 6 Z!3
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 I —Owner Information:
Home Owner Information (To c / omplet te ed, by o of the manufactured home)
Name: A4 a..c1 i4 /c- Address: / i t�� u, c, Li? l
City: L '(oi- Y rir L ` State: de Zip: Z7 Phone: (fig) y99" 73 2
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 mist match information on license)
A. Set -Up C nttractor Company Name:i #-yam. KoLt t - t ,11 ellarc1s
Phone: /9 77) &/ Address:
City: . g StCi Zip: Email:
Setup Signalu � State Lic #3Y
B. Electrical Contractor Company Name:_
Phone: Address:
City: State: Zip: Email:
Electrician's Signature: State Lic#
C. Mechanical Contractor Company Name:
Phone: Address:
City: State: Zip: Email:
HVAC Signature: State Lic#
D. Plumbing Contractor Company Name:
Phone: Address:
City: State: Zip: Email:
Plumber's Signature: State Lic#
Part III — Manufactured Home Information
Model Year:f Size: I X U � Commplete & follow zoning criteria sheet
Park Name: r-yi '_e 4 G( R72J r�r Lot Number: 3(o
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 requireme s, and he Harnett County Zoning Ordinance. I understand that if any item is incorrect or false
information hi' p de that this permit could be revoked.
Sign fur ome 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 12110
MAR -16 -2011 10: 28A FROM:000NTRY FRIR HOMES 9197757533 TO: 919108932793 / P.1
Appllcat on p � / 7b 2 /3
Harnett County Central Permhtl g
PO Box 85 Lillington, NC 2754;
Telephone Number: 910493 -7525 Fax 910- 893 -2793 .hamett.orgrpermits
Aooiication for Manufactured Home Set - o Permit
(Please fill out each part completel
Part 1 -Owner Information:
Home Owner Information (To be completed by owner of the manufact red home)
Name: Address:
City: State: Zip: Da me Phone: ( )
landowner Information (To be completed by landowner, if different th above)
Name: Address:
City: State: Zip: Da 'me Phone: ( )
Part 11- Contractor Information (To be completed by Contractors or Ho eowner, if applcable.
Name, addre & pho must match Inf anon on license)
A. Set -Up Contractor Company Name: M ij I X NEV
PhoneflltA' lt" 31fin Address: Q Slto :VeC I" tv4Y\ �>,V LS 4tSJ4
City:%nf?fd -te: N c . Zip: 7i '? n
Setup Signature; L • 0 0 • State Lic# 3t-4ot3
t ••
B. Electrical Contractor Co . any Name • +" `��� % •. • •
Phone:" 333% Address p -
City: fn.-Crib( State: L Zip: r1 S 30-•
Blectricien's Signature: /i. .: i_ _ ■IrA -• --
State Lic# 4 3 air, 0 -L
C. Mechanical Contractor Compan " ame:
Phonegtrl- L{QR -I 151 Address: . Pidr" ds RA
City: rs?.ae _ State: ■_ zip: 21 3 .
)-IVAC Signature; 4. - - State Lio# 17 S I' 3
D. Plumbing Contractor Company Name: • enter art < U/4 n(vdei✓ S
Phone: ollq - 1 t 3 &oa Address: c25t(p JP•f[ cc MV LS +
City: t.n e t c /n1 State: r( C Zip: 013'
Plumber's Sianature;«cr fH i • 1'584 State LIc# 3L 1O
t
Part 111 - Manufactured Home information
a
Model Year: Size: _ Complete & follow zoning criteria sheet
Park Name: Lot Number:
1 hereby certify that I have the authority to apply for this permit, that the application Is cortect including the contractor
information and signatures, and that the oonatroction or Installation wit confirm to the applicable manufactured home
set -up requirements, and the Hamett County Zoning Ordinance. 1 unders.and that if any Item is incorrect or false
Information has been provided that this permit could be revoked.
Signature of Home Owner or Agent Date
'Effective July 1, 2004, a County Tax Dnaartmnnt Movina Permit must be provided before a Set Up Permit will be Issued. It Is
purchased from the fax office of the county that the home Is moved from. If the home is from a dealer, are need proof of year on the
Form S00 and d available, the serial number. Energy customers moat provide Premise Number.
Lief of Inspections and Egress requirements available upon request. Progress
.s LE s t' s1/ 4. , ,l
r
p I �.
County of Cumberland
M -31 TAXES PD THRU 2011
State of North Carolina 1037551
Permission is granted to the following people to move the mobile noted below.
MCKINNEY, ROBIN ANN
5750 COMANCHE ST FAYETEVILLE NC 28303
Movers;
Make Model /Year Size Vin/Serial Number
1996 MILL 14X80 13833253
FROM; 5750 COMANCHE ST FAYETTEVILLE NC 28303
TO: 36 WENDMIST CT LTLLINGTOON NC 27546
2011 LISTING OWNER ' MCKINNEY, ROBIN ANN
This permit is issued in accordance with the provisions of G.S. 105 -316.1 through
G.S. 105 -316.8 of the General Statutes of North Carolina.
This permit shall be conspicuously displayed near the license tag on the
rear of the mobile home at all times during transportation.
THIS PERMIT VALID FOR THIS MOVE ONLY.
Aaron Donaldson P 1' AIRCLOTH
Cumberland County 'Fa:: Collector