SETUP/PERMIT Application# L&a uLt Ler
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-Uo Permit
(Please fill out each part completely)
Part I-Owner Information:
Home Owner/ Information (To be completed by owner of the manufactured home)
Name: phi ll;S Lied The Coy
Address: 1. 07 Erect tea/ br;v(,
City: k;pA P ,.,)- Slate: Ai C Zip: .J 2)4'1-Daytime Phone:( ) 3 —49/- 7S5-7
Landowner Information (To be completed by landowner,if different than above)
Name: a_j //;c At e. n,l Address: I/O] .rreCf we y ,(bre✓t
City: ikti. Th;.-rt Stale: /ll C zip:-27-le a Daytime Phone:( ) 336- i'9/• 7,157
Pan II-Contractor Information(To be completed by Contractors or Homeowner,if applicable.
Name,address,8 phpne must match information on license)
A. Set-Up Contractor Company Name: e,ctm/a h oleo,/t Nome Ale ye rs
Phone: .?j2 - 23o-0P/0 Address: 205 Bunn /Pad
City: ken ly Stale: NO Zip: e1 7 Si/ a_
State Lic# 3532 Email: CCIL+Mon mAmwa ao7, Corn
B. Electrical Contractor Company Name: Pn we r l21ai#er Lie e+ric /lie.
Phone: 9/17-.537- 4477 Address: 74 a I Purfny Pd. 'Ste 101
City: uY4uy lar;na State: NG Zip: -217103
State Lice 13673 —U Email: bmory4n ®rawer airs ter rice +ric . COM
C. Mechanical Contractor Company Name: ed ,T l/Ca4 -4 Ar Sr1✓ieet1 rev ,
Phone:r/i0 — 313-8057 Address: P. r . Reit 7-37 S
City: Suie5 creek _ state: N C Zip: o27Sob
State Lic# 2 03 80 Email:
D. Plumbing Contractor Company Name: 4 u e ry PI4 m h.n
Phone: lcl -628-1223 Address:
9 .?2�/ Plain V;ew Church ,E':.*ct
City: L}Ncie r State: aP_ Zip: -2750/
State Lic# /0 S 6 — P Email:
Part III-Manufactured Nome Information
{Neelvwe
Model Year: /984 Size: /S.X/o% Complete& follow zoning criteria sheet
Park Name: Rlgdk R/7eA RegmNP Lot Number at /a (a/3ke nderaon 1r)
1 hereby certity 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 hes been provided that this permit could be
revoked.
P. I7/:e A� Iitu. c2017
S' ature of Home Owner or A nt 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 Mat the home is moved from. If the home is from a dealer, we need proof of year on the
Por,500 arra'it available,the serial number.
List of inspections and Egress requirements available upon request. Progress Energy customers must provide Premise Number.
SETUP
O411f
A PLAIN LANGUAGE `, 0 /95
NM
PURCHASE AGREEMENT v BdTURES ROUSING UMW 0
525 Raleigh Road Henderson N.C. DEIVERY�I �� Lyd
252-492-0119 Fax-252-492-0110 " � .t.,.t-,-„�.,,•l Rx, etIt LN
°U Phyllis3J6-
.Mc Coy and EdwardJ,Mc Coy 491-7357 £1702-2017 ' )T.C.
"11E851107 Greenway Drive High Point N.C. 27262 W.S ER OOrrin t
n'his enact Ow gat.L w nSono ew BAm aNrrms.Wer Me aroma Its lion a LaeAu' re a D .
Subject a Int fl and mtlbeaeaa1 side U ft pan'Yen pole n el are I awes epm/aft mwsaaanwet
mm""afleetwood YEAR ®110016 ROORSUE JOONsZE =mouse,
1984 2 L 66 Ire. 14 195
VAF LIAE221909633 17 NEW )C USED IcaDRBeig ^ DELIVERY DALE AErwAaso
}�V�1
LOCATION R-VALUE THICKNESS TYPE OF INSULATION PRICE OF UNT $ 7500 00
CEILING OPTIONAL EQUIPMENT
EXTERIOR
FLOORS SUBTOTAL • ,
THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND
IS DISCLOSED IN COMPLWNCE WITH THE FEDERAL TRADE COMMISSION RLXE SALES TAX 16.0 : tau
16CRF SECTION 050.16:
OPTIONAL EQUIPMENT,LABOR AND ACCESSORIES 'NON-TAXABLE0049
S oa VARIOUSFLWAND INSURANCE ,":1
The Manufactured Home is conveyed
"As -IS" No Warranties whether 1.CASRM4CE / 9
expressed or implied,are made,to - I TRUE.Au.-L••:W $
the condition of the manufactured . LESSS4LOIE0VASOE $
holne for any purpose or Use NET ALLOWANCE i
whatsoever, or as to any other " CASH DOW ROUEN! 1,o0U OU
matter whatsoever except as spec- aW9
IAs. ® s4 OY S.
ifically set forth herein.
_ . ..S1A310TAL i
SALES TAXJNNof MSAXla7A&noj
a-LAli+M09MrIwdCMN8waka ; , -' byB(} >: .OD:,.
EFFECTIVE OCTOBER 11,2063
I UNDERSTAND THAT I HAVE THE RIGHT TOCANGELAHJ,S.
PURCHASE BEFORE MIDNIGHT OF THETHIRD.:
DAY AFTER THE DATE THAT I HAVE SIGNED
THIB;..Ft;
MENT. I UNDERSTAND THAT IS CAHCEU.A 6
BE IN WRITING-IF I CANCEL THE PURCHASE
THREE-DAY PERIOD, I UNDERSTAND THAT THE
MAY NOT HAVE ANY OBLIGATION TO GIVE ME 8Appj-i
OF THE MONEY I HAVE PAID THE DEALER I LIM Mip
ANY CHANGE TO THE TERMS OF THE PURCHA$E14 EE-
MENT BY THE DEALER WILL CANCEL THIS AGREEMENT.
Ramat I authorize Ventures ESTIMATED RATE OF FINANCING 0 ,
Housing Center to use my Escrow NUMBER OF YEARS
Funds for this prosect
MONTHLY PAYMENT$
BALANCE CARRIED TO OPTIONAL EQUIPMENT
CESCPoRW a'TRADEN rEAR
MAAEALDDEL BEDROOMS SZE x This agnomen'contains the Amin understanding bloaan gamand
anal SswLNO. TITLEaJ me and no other rapmslgetlon or inducement wed a
AMXAWraaAG TO WHOM - has been made wltcI It not contained Inglis contract
TRAOF-IN FWRT TO RF PAID BY OFAI FR 0 BUY FR I OR WE ACKNOWLEDGE HECEIPI OF AWRY OF THIS ORDER
AND THAT I,OR WE HAVE READ AND UNDERSTAND THEMac OF
THIS AGREEMENT.
Ventures Housing Center DEALER SIGNED BUYER
NM We Matz Soma
and AmgW Aan OMur NWCa any -
60au.SECurrytio
SIGNED
BUYER
BY
fAeonn. crwonane=nnrNn�/// a�Anc.l�.
r SOCIAL SETMAY NO.
Hamlett Maiming RTS
198 E Front Street
Lillington, NC 2754E
I elephone: 919-893-7525
mmm SALES SLIP 3mm
Geer: TRUCK Type: CP Grime;: f
Dasa: 11/14, 17 52 Receipt co: 151961
Sep no. 5151113
hierck IG k: 2192
C2959309
Lies_. ref q:
UH rd nm: *oo* mmammmm2780
Card type: VISA CARD
Autn Lode: 328851
Sato: 11/14/1' Ilmei 11:.€.53
bent total: 9i5O.09
CARDHOLDER ACKNOWLEOJE9 RLCCiC OF GOODS
AND/OR SEkVICES IN TIE ANDII IF THE
TOTAL SHOWN HEREON AND ALIT S 'O PEEf ORM
THE OBLIGATIONS SFT Fenn fnTEFCnRC-
NOLDER'S AGREEMENT Wird THE
HA*0 CUSTT OMER RECEIR.CCLC*Ti
r
neer: THOU Type: IT [ra42r:
Dete: 11/11117 52 Receimt no: 151961
Year Humber Amount
2917 5994264E
6l HENDERSON DR
CMG:Lk, NC 27591 AERMl! FEES
[•" $152.en
PHYL LIS MCCOY
tender detail A.90
CP CREDIT CARD 81i-59.90
Total tendered >159.29
Total payment
1105 date: 11/1417 lime: 17ai6:L5
fm THANK YUJ FOR YIIR PAYMENT mm