SET UP Payment Confirmation age 2 of 2
Application # l v 7 ' F Z 76 re
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 1 -Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: N/An/C DA v,oJ4n/ Address: Lc'/ 5 Llw SS
City: Con({ S State: PL Zip: 2:75 / Daytime Phone: ( )q /O /g97 -- 00b0
Landowner Information (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, & phone must match information on license)
A. Set -Up Contractor Company Name: Norm en's Th sfa //44to Co- Jn c-
Phone: 9103 Address: /06 Gann Lsl.
City: Show kill/ State: pc Zip: ZS SS'O
Setu. Si. nature _ State Lic# 39/ 3
B. Electrical Contractor Company Name: T D Ce&pf'S r=/Cc..jr,c S-e n&&
Phone: gig/ S2v'1395 Address: 1OZ /Y1 / //2yp
City: &rc/,Sber State: NC Zip: 275
Electrician's Signature: l 6 �e State Lic# / 3 `/`/c/ - C --
C. Mechanical Contractor ompany Name: �rfl f TCn p •, The
Phone: Z5 Z - 4 •9c i Address: ycb &tenwoo/ Arc.-
City: k ni4ri., Sate: / fJL Zip: 2 EirSo l
HVAC Signature: ( z c. State Lic# Ovs
D. Plumbing Contractor Company Name: e i /!'I /up S,nJ s
Phone: ( P e i/ 735 "-C Address: S'/ cis // 7 S- A
City: M•l. D //t“- State: We-- Zip: 2?3 ��
Plumber's Signature: -- T State Lic#
Part III - Manufactured Home Information
Model Year: 7Al f Size: 3Z x 1 LL 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. 1 understand that if any item is incorrect or false
information has a rove ed th is permit could be revoked.
Sign
H 1/-11-16
g l /-11- /
Sin ur 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.
SETUP 4/08
https: / /sec.cdfconnect. cote/ coms /PaymentConfirmation.action 10/7/2010
2010 -11 -03 01:41 BB &T 9999999 » 9192020495 P 4/4
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SUMMIT HOMES OF NC, INC.
D�� HOMES
Smithfield, North Carolina 27577
•
iRy�99�� (919) 202-0400 •Fax; (910) 202-0x06 GATE
� a NNANCCYY DAVIDSON �� -0000 99 8974530 7/1720 0
•
5379 NC 210 NORTH _ AMR a l T/663 �R
DELIVERY • COAT N 27 aeh 5
THIS UNIT IS NEW
l MAKE MODEL STOCKNVMEER SERIAL NUMBER CAVALIER 6501 CUSTOM N/A
YEAR EDROOIIB FLOOR 512E HITCH ,'%• or OR KEY MJ&CERa • - • *e. "T' .
2011 5 2 L 78 iw 30 80 lw 32 WHRFJBLACK AS AGR :- D
LOCATION R -VALUE THICKNESS TYPE OF INSULATION BASE PRICE OF UNIT 9 9 750.00
1 • ! 0.94" 8 . •• 1. z . la— : .I 4:4,360.700
800
EXTERIOR Rai 5 3.5" FIBERGLASS ADOL SETUP AND WARRANTY
FLOORS R42 1 7.07" FIBERGLASS SUBTOTAL . 000.00
NIS INSULATION INFORA6CflON SAS RIRYISHED BY THE MANUFACTURER AND al 800.00
IS DISCLOSED IN COMPLIANCE NE FEDERAL TRADE COWS-VON RULE SALES 1M
OPTIONAL EC;UI , LABOR AND ACCESSORIES NON-TAXABLE ITEMS
BASE PRICE OF UNIT INCLUO. DELNERY AND SET UP. S vARIggggES AND INSURANCE 1.
2 SETS OF STEPS ELECTS HOOK•IJP DOUBLE P ' I..•• [iI - 600.00
ROOF 9ET, CRAW COSTS & RCM FINISH. TAADEaN ••
ESTIMATED SITE IMP LESS BALANCE DUE on above $ ... 0.00
HT %/
BRICK SKIRTING AVERAGE H O x0' , NET S 0.00 I
F.HA FOUNDATION- CASH PCYtAENi
BUILDING PERMITS 600.00 CASH AS AGREED
WATER TAP AND TE•IN I 1500.00 UM TOTAL CREDITS / 0.00
COW/ENTIONAL PUMP SEPT' 6 600,00 SIJB.TOTAL ,. 600.00
DRIVEWAY WITH LOADS OP B TON E M 1.200.00 SALES TAX H Mao • Intruded
FINISHED SHEETROCK IN IR DR MO HALLWAY , • • • URPa1d Balanes of Cash Sale Mee S 1 • -' ' .00
F.H.A. FEESINS�TIONS a GINEER LEITER & BUREWALL ' . '' Dealer and Buyer certify that the additional - ma and
12 X 16 SCREENED BACK SH - • PORCH 6.400,00 conditions printed on the other aide of this • . • • are
aglead b w e p* of Ihle A ram, lha sane IM pfnkd
0 X 21' W FRAME WOODEN FRONT PORCH MP. above th elgna ee. Bayer Is pu a above
desatSd meradso wed homes the d equ i • , and
ecateserbe, the Mamma se cleated hoe bean • umber
_. that Buyer's trade-In k tree from all ektrrw wh .....- • .. except
as noted.
1
BUYERS ARE AWARE THAT AND ALL AMOUNTS THAT tSTDMTPA RATE OF Fa4ANCPIG !G
EXCEED THE AMOUNTS SPE ED UNDERESTIMATED NUMBER OF YEARS
SITE IMPROVEM!NTS' WILL SE A 1007. COSTS TO BUYER ESTIMATED MONTHLY PAYMENTS 5 .. .. .
- - THIS AGREEMENT CONTAINS THE INTIRB UNDE; : T MON NNGG
— WOMEN DEALER AND BUYER AND NO OTHER • • - .
... INDUCEMENT, VERBAL oR worms Has SEW . -- WHICH IS
�.• NOT COVERED M THIS AGREREIDR. -
SAWS) ACIOI NLEIDeL DE A COPT OP ® • • - . AID TWO'
DEALER TO PAY UP $30031.03 IN C l OS1NG CASTS. PRE• I UNDERSTAND THAT 1 HAVE THE RIGHT TO CANCEL
PADS ANDAOR ESCROWS WS i THIS PURCHASE BEFORE MIDNIGHT OF
E THIRD
MAME CAMPO 10 OPTIONAL EASSFI SIT
BOOM 6 BUSINESS DAY AFTER THE DATE THA I HAVE
THIS
NOTC.':lAKHI;Nl'f ldNU('A1:iU `:KAY' > i.lIATA11UN5III utwo Ili r,Orthit . NE` +I I VII u� �H IFIC MUST BE D eecnPnoN OrHaoedl • THE PURCHASE AFTER THE THREE DAY ' • •,
ou eE IRMIS UNDERSTAND THAT THE DEALER MAY ••T HAVE
' �; uo
No, (WM% ANY OBUGATION TO GIVE ME BACK - OF THE
Tm1ae, ants. .. -. l MONEY THAT 1 PAID THE DEALER
MOM IrPOG I Y RHAYt3F TO THE TERMS • THE HPriE
wad 6
ANY DEBT BUYER OWESON - •- 181013E ^ • T ' r 3 r ' •:i' • / / /
summrr a NC. 1 • _ Ea.LER ealcox `0 �.�y ( L ci if �Dr� /! / ist.
E VOSSX ' BUS
Apposed Ii . .... — —
FORM 6004C EJFCTROraC A MAIN LANOUNSE RAOCHASEAGREEMENT wren Ana MOONS 6=609 SOMA •ISOM • NN AMP