SET UP of lyih, (
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Application #
icCt" ... . 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 Information (To be completed by owner of the manufactured home)
Name: Address:
City: State: Zip: Daytime Phone: ( )
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, & •hoer a must mat i f•rmation on license)
A. . Set - Contractor Company Name: 4/ ". ./ / '
Phone: ¶, 2 - � 0 - Address: _ • . ..e
City: .1 - State: / - Zip: ] .. Email:
Setup Signature: —sic, i cT L State Lic#
B. Electrical Contractor Company Name: .Q 29- ' CA.Lt'' X 44"'. eV"—
Phone: 3 ' 0 0 Address $ I2. ;
City: ^4 State: n Zip: '83 Email:
Electrician's Signature: AO G-Oftr - Wk. (i,LaQ, State Lic# / 9 i2 - L—
C. ' Mechanical Contractor Company Name:
`Phone: Address:
ity: State: Zip: Email:
HVAC Signature: State Lic#
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D. Plumbing Contractor Company Name:^�2,4/'E / � ac_ 4 art
Phone ' 7./Or 9/ -lr Address: e%9-0 Krt
Cit State: 44-.4C Zip: 2 7._a Email: nn
. Plumber's Signature: - State Lic# 0 2v< '
Part III - Manuffactur d Home I n • .
Model Year: / 1 /f Size: / X 6 �' 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. I understand that if any item is incorrect or false
information has been provided that this permit could be revoked.
0�'a %t /� -b - / - /2 -0200
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
Form 500 and if available, the serial number.
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number.
Mobile Home Setup Application 1 of 1 05/10
08- 12 -'09 15:18 FROM- WELLONS REALTY 9104362242 T -531 P01/01 U -163
THIS IS AN AGREEMENT AND BILL OF SALE
W.S. WELLONS REALTY, INC.
P. O. Box 766
Spring Lake, NC 28390
910- 436 -3131
DATE: August 12, 2009
SOLD TO: Lorean Moore PH # 910 -893 -8237 gib • 7? 0,
ADDRESS: 100 Loraine Lane
Mt. Olive Church Rd. Lillington, NC 27546
MOBILE HOME: Make; Flamingo Year: 1984 Size: 14x64
VIN# 13809072
SELLING PRICE: $2000.00 Cash X_ Check
SPECIAL PROVISIONS:
1. Mobile home to be moved from 725 Aspen Ave. Spring Lake. NC 28390.
2. Mobile home purchased "as is / where is ".
3. Purchaser responsible for moving mobile home at purchaser's expense.
4. Purchaser responsible for cleaning lot of all debris within 7 days from date of
Bill of Sale.
OTHER:
PAID IN FULL
Lorean Moore shall indemnify and hold harmless W. S. Wellons Realty, Inc., it's employees,
agents or assigns from any and all claims, fines and penalties of any kind relating to or arising
from any matter relating to the subject inobile home.
Notary Public 40" '11 ' _.
i
gnature of Purchaser
Date �
Com. Expires i : lures of Seller