SET UP 09/08/2010 23:31 FAX 9197785448 GOLDSBORO HOMES V1003
Harnett County Central Permitting
PO Sox 66 LiUington, NC 27546
fetephone Number: 910- 893 -7525 Fax 910 - 8934793 www.hamettorp/permlts
a - '
at .5002_500
(Mean fill art each hart compte1100
Part 1 -Owner Information:
Home owners' ilormation (To be completed by owner of the manufactured home)
Narne: ___Cisel ¶ b ro >1Ho a Address:_ d 112 l?wy-3-O a .
Ciry: ___CtstO State: . _ Zip: V5 Daytime Phone: 9i8_7713- 5477.,
Landowner till3rmatlon (To be completed by landowner. if different than m a a) hole '
Nae: _ Hd�i iv 7q `1 tgheaa ._ Address: A. � — - .�. --
Cd VQ ; 1 'c — State: AL _ 42:611.0i . Daytime Phone: ( 34D
Part 11- Cori -actor information (To be completed by Contractors or Homeowner, if applicable.
Name. address. it phone must match information on license)
A. SOLIp Contractor Company Name: Tori Dawson
phone: _9:12 Address: 2180A Mary 1 t1S _._._.
Citgi Goldsboro State: NC , .Z: 2 34
I natYlre; State Liens 3_
� +
E I
8. Elea; rlcal Contractor Company Name: a fill. . ` ea 1 '
Friel Ia: 252 -296 -1026 Address: A k tat -
it i26._ --- State: NC zip:
Et ilc�si n'S SI4naturei _State Lice 7 7 . 1511
Mei hanicai Contractor Company Name:, Jon
/
l ' Phd e: 222- 5D5Q, Address: .f0 301E 535
• 1 t r tir _ . kev _ ' , 44 le: rig Zip: --22 ail ,--.
I /" State Lic# 8
D. Pltprrbing CorfttaotarGom • ,fine: _ Thigpe umbin
C■ 1A -Z9 3929 Address: a • - d.e Rd
Cil i . _rs S1ete:- 2 -
VI Egjn43er's Skin mot:
State Lic# Z4 1_913.
Part III - ell 3nufactured Home Information
Model Year: 2 0 1 d Size: X 8d Complete & follow zoning criteria sheet
Park Nains : _ none Lot Number: _
I hereby col tily that I have the authority to apply for this permit, that the application Is coweCl including the contractor
i3
i et - Lip e
Gorl rnd sionatur,
an ds 1 snd t ' Ottt C Zoning e ordi � Installation wit! conform f ny item is manufactured
Incorrect or false
I
n orm t ta l r a s been t
and es
affil could be revoked.
Mormatio�� S been proyi4 I R�at Pg 4 ED
—9 ..L. .� S Oats
" iEli8Wre o+ Home + ' ner or Agent
'Effective July 1., i 004, a County Id oeggle 1I A�vrag eettra must ba provided before a Set Up Permit will be issued. !t is
purchased from Ills lax office of the county that the home is moved Jmw If the home is from a dealer, we peed proof of year on the
Fore 300 and FPa,v.iilabie. tare Serisl number. Ens customers must provide Premise Number.
List of inspections ::nd Egress requirement; available upon request. Progress Energy
aroe
SETUP
09/08/2010 23:31 FAX 9197785448 GOLDSBORO HOMES 16002
AppHCetfon #___° S 1-5CC1 ( A
Harnett County Control Porinit1049
Piz Box 00 Liltinglt n. NC 27546
Telephone Number! RI 0-000-7525 raft 910.893 -2793 wwW.tinitt,0:00M111e
w C q
Pen f -owsimo k t rmethm;
Home owner rdormetlon (To be completed by owner or the manufacture+, nacre)
Nall l9 Address: 41 1 Z S#toy 7 l z as`
Ckr;, State : 1.143: 27134 DayhlpePhone'(g 77 R477
Lindbyner tintxrnatiwe go ba Completed by landowner, li 0i rerit n obov+r) h
Nara.). , .aS �Y 0 11h1 ts,hlb (
Addreia" - . p ilit.
GO: ii _ . , stela: 4,- , 3ip:1u, 1 oa phone: ( S4D' 4 oaf
Pan U . GoOtroctor Infomtstlon fro he completed by MAIN= or HOMeavmet, ¥ apprieaote•
Name. addfew, 4pone 01N11 rttWWCh hf f1natior en lame)
A. Sett - Jp Contreeler Company Name: fY D vas -
Pheixt: 2011-7_40:1112__ Address: v : Az HII 11 11
Cllr: saboro Stet*: t ._ . MIA - - —
Inslittashavi Mete L1e4
B, Eleclrloaf ConCrector Company p` V 4 / ,► . '" ■e +
Photvi: 252 :�� 6. 1 2 - eta: i. 1
Cary, Stale: _itic _ zip; -
C Contractor MT -
Pha1244 Pf Raix -5.:.5 -
C ity' 1 Stahl: _ J _ ,,,, Zip: , _...,...._ r......
kW t sitifiatwo. ,,, , ,.__.,,State Liao 654 i -
Plutabing Contractor Company Name, Tblaporx 41 b
C0 .
Phortc 91 4- 20w349li_ Addtem : N rk !1 _.
' 1111 State: Ztq: Z 3
' ' pFt:rt rqe; StQrlaEefr$; - - caw Lieff-21,12.11
0 1 4 ° t
t
Part NCI - Mdrvfaoturo0 Myna Information
modal Y o e . 2910 1;20 x IIO Complete & Woof zoning c Minis sheelf
Pa,K Winer nuria ___.........1_ of tfumbor:
i itseelq wit. that t have the Wholly to apply for toe panne, thrt the spesiceeee M stood trtrttu7ing rho ctontrsethr
irdpenhLan ervi a4s ruu, and OW tM GOrlat+vetGOrs Ot inelliatieli 'NW conform to the esidloettle menuleottrtoo home
eel -up t.esubn noels, en. the erred County Zoning Wilmot . t undetallnd Vet It any pent is lococrest ar IiSer
WCtmhtt 41 had Meet 0 • , - - • at ,1 mute be terehet;.
AI
_14. I.A1 . ..- WA
0 &givaw', of Nona Owner etr Agent to
`S #acxIve .ruff' 1. 20 W. s Goan& ImaitgarkagaMmtheigjtma awiet Ai 11vt7viti id tote a Sef ilia Pont* wilt be bausd. ft e
Porothwoci '+A" tfte 3; "x OM &the mew Out the hawk mown trans. If tow lion* • frOm a denier. wv Onloof oe Yds' on In.
Form rode ao1 laver able, $M qMa' aurrimm.
Lief of t+►ep.a%kwu. d Epop seine eynte oval sbre upon mesa Progreso, Energy ousterAfts fees! provide Patellae Womble,
SE11W 4100
Ed WtIE0 : L0 ' E !TOE 80 'd 9L6E- Z6Z--0t6 -T : "UN X'id 9N I HIAtll1d SN9dO I HI : WOdJ
- -• • v uuL4LY HU U HUMES IAJ UO2 `
Goldsboro Homes , L.L.
4112 Hwy 70 East
Goldsboro, NC 27534
(919) 778 -5477
E `taly Jo Whiteliead (PHONE , DAT' /18/10
ADDRESS �- —... - - _.` ' SALESPERSON
_ 2105 Clayhole 'Rd Cosats NC 27521 Jeps Gra
fJFy1y�7grE' I q h J.' C /fI/} ts • k, 4P-1579-4 - -. _
MAKE 8 MODEL lj4( `•�wv�'+ YEAR BRDROOME FLOOR SIZE HITCH SIZE' STOCK NUMBER
Cavalier 09A51 2010 33 76 126.6 8tiv 32,
:i€RIAL NUMBER O 1 f e . 8 _ . p A � ... -. —'
� Yr r /Y` GOLOn PROPOSED nFi- IVFr�Y DATE KEY NUMBERS
Speci O fit NEW ❑ USED
LOCATION i -VALUE THICKNESS TYPE OF INSULATION BASE PRICE OF UNIT $ 87,1 50.00
_ CEILING - 21 - 5 68 .B1 own Cel 1 r1 l cse_ OPTIONAL EQUIPMENT •
_EXTERIOR _ AI__ .._ 3 ..5_0_,,F1 h• Batt g_la ss Batt —^
_ FLOORS 11_,. - 3_. 50 Fi beg1 ags Blanket SUB -TOTAL $ A1,150.00
THIS INSULATION INFORM ■ ION WAS FURNISHED BY THE MANUFACTURER AND
iS DISCLOSED IN COMPLIIJ ICE WITH THE FEDERAL TRADE COMMISSION RULE SALES TAX - f 00 ..an _
I6CRF, SECTION 460.16.
OPTIONAL1 IIPMENT, LABOR AND ACCESSORIES NON - TAXABLE ITEMS
Goldsboro Home; will contract the VARIOUS FEES AND INSURANCE
_
__f01 lowing for1 1. CASH PURCHASE PRIC E $
TRADE -IN ALLOWANCE $ 3'
* Delivery & , _ ?_et_tt, o „�hame $5,2_0,,a. 00 LESS BAL. DUE on above $ _
including 411, level ,__cls�ck, NET ALLOWANCE $
* tomanchOr & tai tor_' trim - DOWN
EED SEE M N $
__b home _mom ex1.stin_g CASH AS er 950._00. /,/,,,
_ & .sewer $01 colts to home 2. LESS TOTAL CREDITS $
_ neither to i sxce _75' - SUB TOTAL 87, 750 y ,90
* Tnsta].1 2 amp. panel _Si _. .wi're . 900 00 . SALES TAX (If Not Included Above)
_
to home _, . •__ 3. Unpaid Balance of Cash Sale Price $
__* Instal l,,....4 t Dn 13 seer hem _pump._ 2,100 _ QQ Dealer and Buyer certify that the addltiona terms and
_ -_ i sta11 mo i.ster harrier 600..00 conditions printed on the other side of this contract are
* agreed to as a part of this agreement, the Same as If printed
__ Brick ski rid ..0VPr ccntrefe 1041.11_) above the signatures. Buyer Is purchasing the above
fnoter_s h surewA 1 1pc _ _piers described manufactured home; the optional equipment and
and a 4' x . 6' hri rk stoop _ accessories, the Insurance as described has been voluntary;
with woad_: ails that Buyer's trade -in Is free from all claims whatsoever, except
_ -* i 1 1 Rackf fhundati nn 1 , 5n0,„0_ as noted.
to
_* Wnnd steps on_ _ . ESTIMATED RATE OF FINANCING % Pass code
_ * Desd nf f ri,t gi 45Q,._0_0_ NUMBER OF YEARS
* Gracie,, 1 . Pv;�L_am41 sQ d 20' out i• -
__ from hi1'Le_ _ ' _ # !,r ESTIMATED MONTHLY PAYMENTS $
* (�raVPl fl Yi_7 63eiH t ill __ ... - t. - ' THIS AGREEMENT CONTAINS THE ENTIRE UNDERSTANDING BETWEEN
Y y n -- DEALER AND BUYER AND NO OTHER REPRESENTATION OR INDUCEMENT,
* Sol 1 T r e a t in p n f-. _ 329,00 VERBAL OR WRITTEN, HAS BEEN MADE WHICH RS NOT COVERED IN THIS
R* 1ARgU F.ng i nej.r_.,Eep / Perm i i s 11200.0_0_ Bu ACKNOWLEDGE RECEIPT OF A COPY OF THIS ORDER AND THAT
.- NOTE ! Sa 1 e cif home doe.; nr t . 4 rjr'lt7de - -- _ _..- BUYER(S) HAVE READ AND UNDERSTAND THE BACK OF THIS AGREEMENT.
whPP l SI, t irPS nr,, .Axw l s I UNDERSTAND THAT I HAVE THE RIGHT TO CANCEL THIS
BALANCE C
BALANCE f) OPTIONAL EQUIPMENT -" . PURCHASE BEFORE MIDNIGHT OF THE THIRD BUSINESS DAY
NOTE. WARRANTY AND EXCL jPONS AND LIMITATIONS OF DAMAGES ON THE REVERSE SIDE. AFTER THE DATE THAT I HAVE SIGNED THIS AGREEMENT. 1
PEBCRIPTIONOFTRAoE.*l YEAR SIZE UNDERSTAND THAT THIS CANCELLATION MUST BE
MAKE hl..) IEL BEDROOMS
- X IN WRITING. IF I CANCEL THE PURCHASE AFTER THE THREE
DAY PERIOD, I UNDERSTAND THAT THE DEALER MAY NOT
TITLE NO SI.F AL NO _ COLOR HAVE ANY OBLIGATION TO GIVE ME BACK ALL OF THE
AMOUNT owMNG To WHOM ! MONEY THAT I PAID THE DEALER. J UNDERSTAND ANY
ANY DEBT BUYER OWES ON BADE IN IS TO BE PAID BY E DEALER n BUYER CHANGE TO THE TERMS OF THE, PURCHASE ACRE EN
TED_ r. .. AN .I
SIGNED X ll �/ ^ 1t-1,.` ::.-- BUYER
GO • Sboro Homes .1....1.... C. DEALER
Nol Vend Unios Signed and A , - Off of the Comp] y or air Au[horhed Agent SOCIAL SE •RUTY . . _ / - _ /
E, s I � i � i SIGNED _ .._ BUYER
' •prownd SOCIAL SECURITY NO _
FOR •
5Q0NC I ® A PLAIN LANGUAGE PURCHASE AGREEMENT Rev 01/04
ORIGINAL Cop 01989 JENKINS BUSINESS FORMS LU17 FL 33548