SETUP & PERMIT Application# I Le JI 1114170
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910.893.7525 Fax 910-893-2793 www.harned.org/permits
Application for Manufactured Home Set-UP Permg
(Please fill out each pan completely)
Part I-Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: C•1.tiV1Th A(AQ C'C Address:
9 'J V 7 k) ( oZ L-I,- 2 �z -, 1
4
City(QyV,rcl\ State: NAC. Zip:,2S 33 I Daytime Phone: fl f-1 ' j ‘c
Landowner Information(To be completed by landowner, if different than above)
Name: O\. F' r Address:
City: Slate: Zip: Daytime Phone: ( )
Pan II-Contractor Information (To be completed by Contractors or Homeowner,if applicable.
Name.addres5s�&phone t match informal)pn o rce s
A. Set-Up Contractor Company Name:KpVtVO't S
Phonec 1 - , ,C Address: " -.;34:) b C ,l^It O 1
City: 116 & State: p Zip:2.133
State Lica A
3t-Ir) Email: l
B. Electrical/Contractor Coo aapvX ame: �c X C, r\
PhonaQ -110ee—Ar�{Z7 l Pddress: a--^'t �e yr
City: � c.tt State: Zip: ��U
State Licq G-10pt✓\ Email: � ./
C. Ph Mechanical - S t Company Name:
Phone • - r:- r��'�dtlress. 111111�,\\\"`III***, `
City: I),11v a State: Zip:
LL
State Licfl ►r��irk Email:
D. Plumbing Contractor Company Namei)Nf. m Iral,N c�
Phone ire ._ . :ill Address: '*S 3 S -
l
City: (C. - g State: t V� (r _Zip: Or.-1��
State Lich M i Email: I]l-..� A _
Part Ill-Manufactured Home Information
Model Year:49 C9 Size: - • X '3( Complete& follow zoning criteria sheet
Park Name: rC oc1 L CD 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 have obtained their permission to purchase these permits on their behalf, and that the construction or
inslallaf n will conform to the applicable manufactured home set-up requirements, and the Harnett County Zoning
Ordina c I understand that m is incorrect or false information has been provided Thal this permit could be
revoke
111151 n
nature dome O r or Age Date
'Effective July 1,2004,a County Tax Deoanmenf Moving Perm,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 04/I1
DBA COUNTRY FAIR HOMES
3335 NC 87 Highway S.
SANFORD, NORTH CAROLINA 27332
(919) 775-3600 • Fax (919) 775-7533
BDrFn�s JauTev �y ry�
ODRF• G Enl'Y L-ti`1-.4'{�`/1ni-�5`145-�_- IF to I1 u ._-
LrL1 Uti5 1' C • `_ . , _ 1 E Li` I �. a3l/�u SeLNSVN /• 1
1 K sMEELL. 'll 7 21"11 Iw/lArn`COA' Ilxl`�L! �o � y��Fy.I�I
4 c-1454D 2015 oe3x Hi(u_7� u�.1ao.
Fr A NIIMBE I Ip I a' E DATE
000. I I_ n/v� r -- o FI 1 F onlr�N! f r u�1�1 c.
f�A�T�1I (-1 'V ] NEW r USED
LOCATION R VALUE THICKNESS TYPE OF INSULATION BASE PRICE OF UNIT
CEILING._- - ___---_-_-- -__._ ; Rt
C-O4O(.. 0
EXTERIOR OPTIONAL EQUIPMENT
FLOORS
SUB-TOTAL i5itie sJd `L
IRIS INSULATION INFORMATION WAS FURNISIIFD BY THE MAMA ACTURTR AND
IS DISCLOSED IN COMPLIANCE WITH IIIE FEDERAL TRADE COMMISSION RULE SALES TAX
ICER SECT ION 460.19.
}�_ _ OPTIONAL EQUIPMENT,LABOR AND ACCESSORIES NON-TAXABLE ITEMS
e��.471/4' SE-' x-f" I'S VARIOUS FEES AND wsukANce (�+1fn�/�/��/� /�
cs CASH PURCHASE PRICE 1&� .�
L� y p1 TRADE-IN ALLOWANCE IS
I -'-' F-_1 LESS BAC.DUE on ohs vel$
NET AI I.OWANCF S
°-It R V CASH DOWN PAYMENT IP
�J t , CASII ASAGREEFJ IL
i. LESS TOTAL CREDITS
- SUB-TOTAL c
SAL FS TAX(It Not Includea Above)
Uqp id Balance of Cash Sale Price
Dealer and Buyer certify that the additio al terms land
conditions printed on the other side of this Agreement
agreed to as a part of this Agreement, the same as if pri
above the signatures. Buyer is purchasing the ab
described manufactured home; the optional equipment
accessories,the insurance as described has been voluntary;
,Vf 1 ,o. • Buyer's trade-in is free from all claims whatsoever, ex
11 in die . ,r. sir
-
as noted.
ESTIMATED RATE OF FINANCING
NUMBER OF YEARS
ESTIMATED MONTHLY PAYMENTS$ _
—_. U--_ DING DELA AGREEMENT CONTAINS THE ENTIRE RNOEft ESET
INDUDEALCEMENT,
AND BUYER AND NO ,OTHER REPRESENTATION ISOR
INDUCEMENT, IS OR TITTEN, HAS BEEN MADE WHICH IS NOT
COVERED IN THIS AGREEMENT.
BUYER(S)ACKNOWLEDGE RECEIPT OF A COPY OF This ORDER AND THAT
BUYER(S)HAVE READ AND UNDERSTAND THE BACK Of 71115 AGREEMENT.
H_
I HPURCHA THAT I HAVE THE RIGHT HT OFT CANCEL
THIRD
BALANCE CARRIED 10 OPIIDNAL EQUIPMENT THIS PURCHASE BEFORE MIDNIGHT T IH THE TRIED
$ BUSINESSISAGEEMEDAY NT. THEDATETHANIHTHESIGNED
NOTE: RION of TYAND EXCLUSIONSAND UMRA710NS OF DAMAGES ONTHE REVERSE SIDE THIS AGREEMENT. I UNDERSTAND THAT THIS
IILscrarnoN al FRAIL 14 YEAR inCANCELLATION MUST BE IN WRITING IF I CANCEL
.tea ,,.,,D„ • THE PURCHASE AFTER THE THREE DAY PERIOD, I
°L O1'"un UNDERSTAND THAT THE DEALER MAY NOT HAVE
t or NO ,IRA I,.. ANY OBLIGATION TO GIVE ME BACK ALL OF THE
•-CDN1 n1.�N�.ln wnoln MONEY THAT I PAID THE DEALER. I UNDERETAND
ANY CHANGE TO THE TERMS OF THE PURCHASE
ANY DEBT BUYER OWES ON TRADE-IN is TO BE PAID BY DEALER BUYER AGREEMENT BY THE DEALER WILL CANCEL THIS
AG EMEND. � tl t•4_
E. J. WOMACK ENTERPRISES INC. EA s•R.ur-x�CJNAo
DBA COUNTRY FAIR HOMES AIEe amr
N Y.' Imeessy ¢p x rm gpmpme Olre oI e Cry ur of SECI WRIT NO N
By B Lee t
ApyrovenFORM 500NC 1 ® A PLAIN LANGUAGE PURCHASE AGREEMENTY a 100 JI N
NK 'BUSINESS FORMS•HBO 8514414 0.,OG n1
ORO- r-0V
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Application Number 16-50040028 Date 6/15/17
Property Address 22317 NC 24/27
PARCEL NUMBER 09-9556- - -0030- - -
Application type description CP MANUFACTURED HOME RA20R/RA20M CRITERI
Subdivision Name
Property Zoning PENDING
Owner Contractor
SAUNDERS GLENN RAVEN ROCK MOBILE HOME MOVER
3335 NC 87 HWY.
22317 NC 24/27 SANFORD NC 27332
CAMERON NC 28326 (919) 775-3600
(919) 499-5495
Applicant
SAUNDERS GLENN
(919) 770-1024
-- - Structure Information 000 000 24X56 3BDR DWMH
Flood Zone FLOOD ZONE X
Other struct info # BEDROOMS 3 . 00
MOBILE HOME YEAR 2015 . 00
PROPOSED USE DWMH
SEPTIC - EXISTING? EXISTING
WATER SUPPLY WELL
Permit MANUFACTURED HOME PERMIT
Additional desc .
Phone Access Code 1196179
Issue Date . . 6/15/17 Valuation . . . . 0
Expiration Date . 6/15/18
Permit LAND USE PERMIT
Additional desc .
Phone Access Code 1196161
Issue Date . . . 6/15/17 Valuation . . . . 0
Expiration Date . 12/12/17
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call : (910) 893-7525 Fax: (910) 893-2793
Bldg Insp scheduled before 2pm available next business day.
Page 2
Application Number 16-50040028 Date 6/15/17
Property Address 22317 NC 24/27
PARCEL NUMBER 09-9556- - -0030- - -
Application description . . CP MANUFACTURED HOME RA20R/RA20M CRITERI
Subdivision Name
Property Zoning PENDING
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . MANUFACTURED HOME PERMIT
10 501 T501 R*MOBILE HOME FOUND. / M. WALL / /
10 814 A814 ADDRESS CONFIRMATION / /
20 818 Z818 PZ*ZONING INSPECTION /_/_
30 507 T507 R*MANUFACTURED HOME FINAL / /
999 H824 ENVIR. OPERATIONS PERMIT / /
999 H828 ENVIRO. WELL PERMIT / /
999 307 P307 R*PLUMB WATER CONNECTION / /