SET UP n
Application # / 5 2 4 '1✓ ;
Hamett County Central Permitting ,
.. PO Box 65 Lillington, NC 27546
Telephone Number: 910 - 893 -7525 Fax 910 - 893 -2793 www.hamen org/permits
Aoolication for Manufactured Home Set -Up Permit
(Please 011 outeach part completely)
Part I -Owner Information:
•
Home Owner Information (To be completed by owner of the manufactured home) •
Name:1,r•,-W. SrF \�l%(1 - Address: 3K' 1 ra io)r\ l .ie-
city: Li 1 I i n l-on State: NIL Zip: 0275Y10 Daytime Phone: (9,a) 237 - c 5st
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, 8 phone must ma infomyatlon on license)
A. Set -Up Contractor Company Name: R-s- i-e t. I to ,- 0 7s.rr r. hr/no cry
Phone: / li 1 '7) 5 3 L. d Address: f/4 ;letile s us. s /�!
w ur a 4 ..
City: State: ii, !' Zip: 2 '7 3 3 t
Setup Signature; 46,a1 2 r, State Lic# €1 O 0
8. Electrical Contractor Com • any Name: • ( i
-
Phone: � - w u a = _, - Address: a� �, A
CC
City: Ia a. '-' 'State: • Zip: 77f7�5
Electrician's Signature; ' s G t-4 - t 4i - - - Stiite`.Lic# ../7 . 2C -- `- -
C. Mechanical Contract. Compa 'ame: 4/9/7
Phone: Address: _
City: State: •
HVAC Slonature; State Lic#
D. Plumbing Contractor Compa :me:
Phone: Address:
City: Y State: Zip:
' .-:I - '1 1. j.
State Lic
Part III - Manufactured Home Information
Model Year: 19 k 7 Size: f tX 7y Complete & follow zoning criteria sheet
Park Name: [ 7 b. 2 eLoni:1 �J 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.
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
Fonn 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
� r .., ; 'L A it p' STATE, NORTH'CAROLINA x' `- "! ' ' c .- �. s J : :s 1� : f t 3f- /3+vl lf�a „s��a••/s3 � R 191IRev 05/07)
CERTIFICATE OF TITLE
P",..,..
,
is q 7 I ; ,-VEHICLE IDENTIFICATION NUMBER YEAR MODEL MAKE - BODY STYLE
507SM220H0878' 1987 MEAD MH
r. '4; TITLE NUMBER TIT1_E " ISSUE DATE PREVIOUS TITLE
- 772886101027047' 04/17/2010 - 7742681006
t .. .._.
` 5. � ..,» . ' lllIIlllllll' llll' lli kes ilI111II•IIlIIIIImlu•IIlusehlrl - ODOMETER REA
LATESHA BERLINE SHELVIN
$' 37.0 MCKAY DR
f 9 SPRING LAKE NC 28390 -9430 " ODOMETER STA
aft
� 'f1TLE BRAND
r i , q
p, . ,
p OWNER(S) NAME AND ADDRESS
l' a.- LATESHA BERLINE SHELVIN
.. i 370 MCKAY DR
t. SPRING LAKE NC 28390 -9430
8
111111111011111111111 III110111111IIIII111111111
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The Commissioner of Motor Vehicles of the State of North Carolina hereby certifies that an application fora certificate of title for the herein di
19 has been filed pursuant to the General Statutes of North Carolina and based on that application, the Division of Motor Vehicles is satisfied th
4+ i is the lawful owner. Official records of the Division of Motor Vehicles reflect vehicle is subject to the liens, if any, herein enumerated at the i
of this certificate.
fi
i ASsT in_ and sea! of this Dwiston. of the day and year appearing in this certificate as the title issue date
N.a l,. COMMISSIONER OF MOTOR VEHICLES
�. 1 ; FIRST LIENHOLDER: DATE OF LIEN
LIEN RELEASED BY
r - . - SIGNATIIRE._-__-_.-__.. ______ —__
' TITLE
^I�' SECOND 1 IENHOLDER DATE OF LIEN
LIEN RELEASED BY
.SIGNATURE__
t TITLE ___ —___DATE_
r THIRD LIENHOLDER: DATE OF LIEN
^' LIEN RELEASED BY:
L SIGNATURE__
s ' TITLE _DATE.__ •
rte` ,
• P-
FOUH RT LIENHOLDER: DATE OF LIEN
r j t LIEN RELEASED BY:.
ef [� SIGNATURE.
F _ TITLE.___ DATE ___
Federal and State law requires that you state the mileage in connection. with the transferor ownership. Failure to
in fines and/or imprisonment.
• ; ;, a FIRST TITLE BY REGISTERED d
,The u he re b y e m l a s [h th e ve h .' d m this bile Imo Men uansferd to d¢ pnnled name and add
s i. ' '[ r ,r v t k d..- &�3 s '"1, S t " tw x 4 ' s" -�
N a a of Buver �' t v - -Si
AddhsorHu -(: "' 14 • z i " d. -
'1'sellcrls) ccnrfy to the best of my kn that the od rcadrng clnd ,
tie r S +v.W c . Y vF J
actual t k go of rho. vehicle onles+ nc of t 1 Ilu ng stale na is he✓ x :f^f t, -, rc fir . + ( n
v ▪ 0 I Dre n l sl ticd is to uresa01 Is r T SccIlet(s) Ha Pr N ti_v Y •h JJ �
mechanical LmiB - - -
'� Iht f �' C r
' Ur 2 The odometer'trading rs no[ the acual ' S ad• :
:ODOMETER READING r n5: le
tmnga +'t " 5 f N ,;; ,"r r ! f e r I iii,'; the f Ilf wing pctxanl }part nlll nppe r x t •
'' reel WARRING 00oMET R DISCRFPANCY ao sgncd the 1'i regrn g d ument fot the 4 pi Toony knowledge ttie vehicle described herein ra k 3 ' e L 1F c o r 7 .j --Y Ar` < _J
Y
1 1c^'❑ No r'Orll s t ine tm oh edc oro aee , g - , r Ntxary Rhlc5gmiu `�'""
L R )7e'4the cstont that the cos[ m re pine exceed9 2s'h oP * L v 1- n tinS n,?')„y x a p '✓ 'i p / •u r
• " •' �N PnmalmT dNeme. F "`� x, r
n i ".fan mnrkG.value.'a.. 1� t �Si v e t .•. - , > r ours' YPe
Yeses ❑ Nn ❑ ,Has been a flood vehicle • L d . r s c + r .s My,(. wnnuss oa expires_ • •• ` •
\ es.' CI No ❑ Has hued a reconnntcled or a salvage veh cle hti [c� t ( l r ' rva ' rS .ii
- a .. s t 5 9 ,,, +'*.av Bujer(s) Stgnae - ,
ti F f' " °1,r '2 ) M r . , a r?'.`.+y4 " 1 fika rz a c ?I•" r S , r a'x' a .:e � .
Date vehlde (0 p r "'� - " ° ^ '` Buyers) Hand Painted Name'' •'� _3 a'
- ' '` 4 ;,. _ s r ' FIRST RF A OF TITLEfBY D E A L E R
P x Th un hereby cerurei t hat the vehi described to t tit ha keen transferred to the following eddied name and add
n.:�: 42, ;;; w . : "r t p-v 0l iad'., '� ; gib d. ... ' n , L '"�'+^' „,,
Name of Buyer
t /lddresa of Buyer s ` • a-r "fi +t t; -e1ti ?r>t A= e t C Sy W w iy ! ` t i 1 • a t at 0 * 4 x g v a Deuler(sl hmoe2'a [. sS y ss r s
c • scitet(a) emfv to'the best of my kuowie a f th t n he odometer in chc k then �r , ad i ua v l+v.t o- g n
r actual mdu a of the vehicle uNess m • of the -, 7slat is check d a4 iron s a l -.
s b . g_ 3 yy $ Uvalerta} Stgnamr!
❑ 1' The tmlcaga tared u In uems of rte �' Dea leds) H and Printed Name -
. > n inechantcal I mtts?a T .f _ ' Dav ar It ' . -`' ` Cminty
r . . d'.27
2The odonie¢r rezdmg Altai the octal ' . L , I , .: a
> ODOME RE t ,} t +,nndeag F h + f re c,-,) f I cn r dtm the f Ilow ng pert n(sl personally appeared b
n" d
Y is (Ab feafheJ : t i WARNIND ODOMETER' roscREPARCY f ys gnW the k ftrcgwngR document f i a ?
To my kn wledge the,seh¢Ic descnbcd Mrem ` t r ' ..
Yea U c . ,, No ❑ Hoe been nvol ed m a colbston o tith cc u ne nco to 4 , Ly
,� t r S i hoary Publ • gn o mic i E
} . • s 1 )he extent then tbe, os[ repan er4eeds 2 5 % of r y ..4s r (Ff„-. r bh or ti p :,C.-t-''.--' ca r< '
r ,:fair market vnlue. -
t t } y Noury s print nr Typ ed Nome
, No ❑ Tim been a On r Cunanw up
Yc t ❑ No ❑ Has b een a recn aswcted or a salvage vehicle y , t } + r r - y - agi t t v
p % Bu)ar(s) Stgnatre
r -1 „ d+n, _. -.'L� "
l �' "' ',4'd ,e t` ) c a m, fid ) ..' ' ?t r :
.Iyale se hid e dellvered "` ° ^ • " ' u Hnnd Primed Name'
_ PURC HA S ER S A P PLI CA TION FOR NEW CERTIFICATE
r '; The un d pu rch ▪ a ser • of th decri o n t h e face of this cemficate h ereby mak a f or a new cemficate of It
a '.hen and none other and that th comained Gerald is tru and a to ny bees know q ledge and behel k ",f` ,� rs `" v "'
OWNFHIS)` a ether
' S t m "0 3'y
Owner 1 DI. ?" . i >
2 j s y 3 Pica -., Y tome MOwott IFIrN; Middle Lur:1
1 • i • - 1 :a ( ,`,",.;12:;;E, icy , ...:"< a 4 '
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r o7 .ti V 1 ° a ,. a t .n s a rs* 6:a � � " t L pa bi. :
Os�ner 2 DL71 v Y �. .+•
'-1.- p ry k� F --; _ tome ur Owner:Flit. Mlddlq I.nt,
i X rf -e re ° -Z do a 1 h °\ S 8 r
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lie'dence Addrsw+
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Nail Addreea (I d ffeinnt from abose1 n f Gn r ' "ti 'uic b '!.,l'''1
FHiST .L116.— IEN ' t " ` r w ' ' aI f SECOND LIEN ;'{'t t '=
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.. Ltcnhnldm a .w. •...,t, ,• .,, -. >l u= .. .ti _. .- i ' ... r , .. - sf1 s4 .a." 'Licnholdcr .� .,a ..r, .r �ftf