SETUP/PERMIT Application# ea(-0(1e7
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-UD Permit
(Please fill out each pan completely)
Pan I-Owner Information:
Home Owner Information(To be completed by owner of the manufactured home) y5�,
Name: l pnll;- 4E4 mcep Address: x/07 6rcen y JrrvP.,
City: 11;54 PeenState: h�C Zip: J lab Daytime Phone:( ) 314; —<f 9/- 7357
LandownereeInformation (To be completed by landowner,if different than above)
Name: pi,j Ms A ty Address: lNO7 , reen way Dry kO
city: J4h !%&A+ State: ft)C zip:-27.-4 a. Daytime Phone:( ) 336- 6191- 7357
Part II-Contractor information (To be completed by Contractors or Homeowner,if applicable.
Name,address,a phpne must match inlormation on license)
A. Set-Up Contractor Company Name: Eastind A (nob;l6 mem e. Mu vers
Phone: 432- 3D-0810 Address: 205 &An Rad
city: Ken ly State: Ne zip: a 7 5'1',-2—.
State Lic# 3532 Email: CcL4rnon rAin&g. aol. Coln
B. Electrical Contractor Company Name: en wr r fllas4cr 6Je c#r,C Inn.
Phone: cid-559- 4/471 Address: 74 a / Pur fny Pd. 99 /01
City: Fa pay Varna State: N C- Zip: -2'74-03 /o
State Lic# 13673 -U Email! .j/Mr tin Ore nieslL'r e/u 't'ric . Coin
C. Mechanical Contractor Company Name: 4-4 IT ilea-1 4 Ar. ¶efUIre Tr,r ,
Phone: '7)0 893-8057 Address: P. T . R&t 7.?7 t
City: Rule5 Creek Slate: NC zip: 027506
State Lic# 2 03 WO Email:
D. Plumbing Contractor Company Name: Aver'/ Plgmhiny
Phone: '7A 42-322,3 Address: 3291 Plan Vreu Church Road
City: e't//LAi/iF l- State: pi Zip: -2750/
State Lic# J l0 &26 - P Email:
Part Iii-Manufaptured Home Information
Br) cd,er
Model Year: /598 Size: L..x 76 Complete&follow zoning criteria sheet
Park Name: ark RIveA gig H1H P Lot Number:. 9 (Its &nSrrs'm 1r•)
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
installation will conform to the applicable manufactured home set-up requirements, and the Hames County Zoning
Ordinance. I understand that if any item is incorrect or false information has been provided that this permit could be
revoked.
( P.c...11 J ie (a' &nl/. 7ao/7
Si azure of Home Owner or A nt Date
'Effective July 1,2004,a County Tax Department Movino 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 04/11
A PLAIN LANGUAGE cc `' �i 1
PURCHASE AGREEMENT C y ENTURES Houma cense WL/ I-71
525 Raleigh Road Henderson N.C. �reLm / 1 —
252-492-0119 Fax_.252-492-0110 Prato -f1%_ +'-�'.-+a9 h_n . 7liyjrk7l� 'z
°1RalwPhyllis Mc Coy and Edward Mc Coy 3M6-491-7357 n1 02-2017 V
"W1107 Greenway Drive High Point N.C. 27262 W qA Currin
in flu masa ae.ane.Lsm..mea sr mf.buss;.mtosRr W+a ma a am Therca alaem[wino t.Ot.
SLAW m Mg emsmamwvs anaan,dn aOYaewa.ne_pi age m ram lsums patina ay taming detested a*
"a Them`Brigadier raR en aonla nn°°sm_ Ia7Ursw lE Pommies'
1998 3 IL 76 lw 14 L80 I 14 172. .
66665 CINEW MUSED Q01DRWhite PROPOSEDARRn r'E rErNIAeam _
_ 44
LOCATION R-VALUE THICKNESS TYPE OF INSULATION PRICE OF UNIT $ 19,500 00
CEILING OPTIONN.EQUIPMENT
EXTERIOR
FLOORS SUBTOTAL
THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND
IS DISCLOSED IN COMPLIANCE WITH THE FEDERAL TRADE COMMISSION RULE SALES TAX - 463 . uu.•
15CRF SECTION 460 16 _
OPTIONAL EQUIPMENT,LABOR'AND ACCESSORIES NONTAXABLERSE
$ It VJUOUSFEESMIVUSRAN(E
The Manufactured Home is conveyed
"As as" No Warranties whether 1:CASK PRICE... 353.5104^
expressed or implied,are made to - - rwDEENAL :ANC. $
the :conditionof the -Manufactured - anBAI-'OiESSAaxE $
home 'for any purpose or Use NETALWWAYCE $
whatsoever or as to any other CASHODWPAYMENT .QUO .UO
matter -whatsoever except as spec- G✓®
CASHASAwrRnaaW $
ifically set forth herein. 2.1.ESSTOTAL[ SITS ;.:
sue-rorAAi�ss-; y,
C4LPo TAXfKN lDashAIdAbweJ
tuap.easbrgeotoehSIS Prim bE1 U➢•
EFFECTNE OCTOBER 11,20163
I UNDERSTAND THAT I HAVE THE RIGHT TO CANCELIRSS
PURCHASE BEFORE MIDNIGHT OF THE THIRD BUS ISAA
- A
DAY AFTER THE DATE E OATS THAT I HAVE SIGN
MEM. 1 UNDERSTAND THAT THIS CANCEUATkee,
BE IN WiURNG IF I CANCEL THE PURCHASE
THREE-DAY PERIOD, I UNDERSTAND THAT TH PEA hf3
-- - - _- - MAY NOT HAVE ANY OBLIGATION TO GIVE ME i*cre&f.
OF THE MONEY I HAVE PAID THE DEALER.I UNDERSTAND.
ANY CHANGE TO THE TERMS OF THE PUACHfti,ScJfl-
MENT BY THE DEAlER WILL CANCEL This AGREE
-R WAS I authorize Ventures - ESTIMATFA RATE OF FINANCING 0
'n• Center to use In _ - "row NUMBER OF YEARS
Funds or t 1s proiec MONTHLY PAYMENT$ .
BALANCE CARRIED TO OPTIONAL EQUIPMENT $
_DESCMTOR OF'neOfM YEAR . .
aAKEAlcoa BEDROOMS SIZE X This agreement contains the entire understanding between Yo�ii Arid
COLOR SERIAL NO. nn<w me and no other representation or Inducemeit,verbal or velem
Aarbwromxc TO weal has been made which knot contained Minn centrad.
TRADEIN OFRT TO RF PAID BYO DEA/ER O BI/YER 1 o WE ACKNOWLEDGE RECELPI OFA COPY OF THIS ORDER
AND THAT I,OR WE,HAVE READ AND UNDERSTAND THEBACKOF
THIS AGREEMENT.
Ventures Housing Center DEALER SIGt.EOX BUYER
•w WULimon Spood and Ama.]by (Siker a w Celc.nv
SOCIAL SECURITY
�' I BUYER
SlnniFDX
�// t 'All Vti'h socio SECURITY NO..Y 1?
Amvsel&area..rab,eri*of AVMie by bM Of Frere.WwuM
Harnett Planning PGS
108 E Lillington!rentNC Street
Telephone: 9/8NC-893-7525
44* SALES SLIP 44m
Omer: :NOCK Type: CP D^aw(r[ 1
irate: 17/14/17 52 Reeeret nn: :51963
Perch IDA; Seq n6. 519?lui
Cooped *elk; 1082
Left, ne: exrx4wapawax2780 J2o45y3F
Care type: VISA. CARD
Muth code: /29348
Late; 11/14/J' Time; 13.17;15
Payment total: 1:.56.0E
CARDHOLDER ARKNOWLEDSES HTICIPT j3 GOOLE
ANDIOR SERVICES IN THE AWAIT 5S THE
TOTAL SHOWN HEREON AND t rc v TO PERFORM
THE OBLIGATIONS SET FORTH TO 7,4E CARD-
; HOLDER'S AGREFI,ENT O rrP THE IS LEE
Signature:
HARNETT COOKY CASH rtECEIpT
v%i CUSTOMER RECEIPT ,..�
Osier: JNRGCf Tyce:
Brite: 11.S4/17 5e hecei; o .1363
tear Number Am aunt
2E1? 5804264?
:15 HEND`_RSON DR
ANGIER, NC 27581
PI PP - PERMIT FEES
EOM 5/58.85
•
PNUL!IS MCCOY P.•
2Tender detui
r CREDIT CARD '.50.e
FotLI tendered
Ictal yaynent 4158.08
4157'.20
Trine date: 11/:4/17 Time. t3:I7d3
•r THANK YOU FOR YOUR PAYMENT **