SET UP •
I 9 . fig �4 �
r 7 . ' Application # l 0 r C
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 Owner Infor Son (To be completed by owner of the manufackred home)
Name:: / i a /I Li Address: // 5 d 23 O �% 3 ' 2 7// 1
City: / ;_ / //J
I/ State: /` `- Zip: Daytime Phone: 94) g Qc
Landowner nfor ation (To be completed by landowner, if different than above)
Name: Address:
City: State: Zip: Daytime Phone: ( )
Part 11 — Contractor Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, 8 p one must mattep mforma i n on lice
A. Set -Up Contractor Company Name: S Ade-J lohiIa ii sst�-,l'l
ctu
Phone: /�7�7 O1o2,3 Address: /635 4 s4 u.nl n Rosa
City:
• r -4 te: C-. Zit: 2 7509'
Setup Signature: State Lic# .2 vsi
B. Electrical Contractor Company NamerjaM MA MJ 3Q s Le
Phone: 0- 9$y- 605 I Address: 141 Frei Mgt Lowe__
City: State: NC . Zip: 2 752-
Electrician's Signature: / State Lic# ..26731 C. Mechanical Contractor Company Name Art( SAoc /
Phone: fig- (024-2174 Address: 6 (1r: -4 Z
City: i 1 iN State: /v C, Zip: 2751 Z-
HVAC Signature: V--,, IIL-i State Lic# 1 2730 #3 tt14sS
D. Plumbing Contractor Company N e: Aft f,/ r et
Phone: T/9 39 - _7 20 Q Address: /"Q-B ")( 255 i t /dif /2rh� A(C.
City: 4 Sae / r Site: iVc . Zip: 2 751 2 O
Plumber's Signatur: • State Lic# /755a P 1
Part 111 - Manufactured Home Information
Model Year: 2 0/1 Size: 72X 1 7
i 7 # of Bedrooms
Park Name: L/� /// 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
informatio has been provided that this permit could be revoked.
A / I�/i r 4 7a6' /b
Sign - i- e of Home Owner or Agent to
'Effective July 1, 2004, a County Tax Department Movina 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.
2/06
SALES AGREEMENT CMH Homes, Inc.
PO Box 9790
CUSTOMER Maryville, TN 37802
DATE: I' /z.w 00
BUYER(S): nn L-C• N. %fr C AI SSN:
akfees ,SA BeR- E. /He/ N SSN:
ADDRESS: 115 7 014 a S. 2/ It141,7, / n, /VC. .G 7re/6
DELIVERY ADDRESS: 7)0: /
p 7 ,
TF- LEPHONE: 9IA- s 3 81 HOME CONSULTANT: kfair
BASE PRICE' $.7 d Silf. 51 . Make: e teriiii,..L. odeL•
SUBTOTAL: $ .SS n 3 Year: 0G o Length: 52'• Width: 1 'Stock #: l a
SALES TAX: $ G 0e °t' Serial #: RQC 12 / i9 i(ta 9 New ❑ Used
/� e
C rb re t $ /7 / /d t? • 3 Trade: Make: ' Model:
$ Year: Length: ' Width: ' Stock #:
$ ' Serial #:
1. CASH PRICE: $ 74/ 27 J`rl . ' Amount owed will be paid by: ❑ Buyer ❑ Seller
Trade �owance $ Owed to: t(���� ,
971Ea $ VO e ... OPTIONSS Toni /3 YE- mow; /
Trade Equity $ 23e h q wd rip S, L'rkG M.a_ r' r--
Cash Down Payment: $ 2 U » 9• 0a a ear+talf ht- ,gtea.., . (js -" plg..,.6 L enetw
Other Payments: $ f4Cer•se+ A
4/
nti v1Mc s
7 yk iic4 ,
` 1J 4Cad s� - 1 *
2. LESS ALL CREDITS' $ f 2Q & Q � / SELLER RESPONS[BII.1Tll C I. 4
3. REMAINING BALANCE $ .sue/ . g o e✓ Ciu,v cam:_
ESTIMATED MORTGAGE. Buyer is voluntarily purchasing any /
insurance products listed below. All numbers are estimated.
A. Other Charges $ BUYER RESPONSIBILITIES: PPrt.ag.. h
Property Insurance• $ CL-0 i nl / . tPGS _ - he 67
Credit Life Insurance• $ hii— � dal. /At a ezesle�/�
HBPP• $ O
Title Fees- $ May not meet local codes and standards. New homes meet
Federal Manufactured Home standards.
License Fees $
$ Buyer(s) agree: (1) that the terms and conditions on page two
are part of' this agreement; (2) to purchase the above home
$ including the options; (3) they received and acknowledge
$ receiving a completed copy of this agreement; (4) that all
promises and representations made are listed on this
TOTAL: $ agreement; and (5) there are no other agreements, written or
B. Unpaid Bal. /Amt. Financed (3 +A): $ verbal, unless evidenced in writing and signed by the parties.
C. Interest Rate. % (W.9 BUYER
D. Finance Charge• $ X yy e
E. Total of Payments (B +D): $ z , (ri 'hr` �Y
F. Total Sales Price (1 +A +D): $ X .. seat
(signs.ure)
G. Number of Payments. # X
H. Payment Amount. $ (.Ign..ur.)
This is not a loan commitment. X
(signature)
Rev. 10/08 Multi State Sales Agreement (excluding NC & VA) CMH 1179
Sales Agreement (generic) - Multi /476