SETUP/PERMIT Application8 L4 auUS
Hamar County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.orgipermits
Ag0lirsli(Please Manufacturedllout each Permit Home Set-Up e
art completely)
fill
Pan I-Owner Information:
Home Owner Information(To be completed by owner of the manufactured home)
Name: rAi lits 4E4 McCoy Address: PID 7 Grain11-0-1brrv�:
City: Nrj Al Po:a 4- state: AI e, Zip: -))1G 3..Daytime Phone:( ) - 49/- 7357
Landowner Information (To be completed by landowner,if different than above)
Name: t143/115 M c Coy Address: /107 4retn coo y D ri✓t
City: µb,11 f:0Mn+ State: flit Zip:-I7.aea Daytime Phone:( ) 336- 49x- 7357
Part II-Contractor Information(To Namer,If applicable.
e completed
Contractorsby
addreess8 pnppne must match Information on license)
A. Set-Up Contractor Company Name: Eat/na A (fl°bete, //cme MO of r5
Phone: . ca - a 30-Or4/O Address: 20 5 8411 A RAI d
City: Ken Iy Stale: /Vl. Zip: a7 Ste).-
State
t.).-
State Lich 3552- Email: Ca--fn on mhm& au/. Corn
B. Electrical Contractor Company Name: en we r 1lkas4er Ele c+tic Int.
Phone: (in- 559- 84'77 Address: 7L.IL A I Purfny Pd. go /0/
City: Ff(gaay Varna State: AlC, Zip: -Y7Sate
State Lice 13413 -1/ Email: b morgan Cif power mets tr elet fric . Com
C. Mechanical Contractor Company Name: Rct tT Nca1 - At Se rw;r P. 7"nr r
Phone:7/0 - 893--805 Address: p. n . ROC 7S7
City: Rules Crce1C ._ state: Al C Zip: 017506
State Lie/ 2 03 &0 Email:
D. Plumbing Contractor Company Name: Avery P1kmhini
Phone: 7 -1x28-3223 Address: 312, Plain View Church Road
City: 411/1; r State: Alt Zip: -2730/
Stale Lill • 10 1164- P Email:
Part ill-Maannufpctured Home Information
Model year: /991 d Size: d__x 9b Complete a tallow zoning criteria clintar 73
Park Name: Block Rhea RiN AHP Lot Number# // (� Menders(n 71r.)
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 Harnett County Zoning
Ordinance. I understand that if any Item is incorrect or false information has been provided that this permit could be
revoked.
Scl4P.c-,/ fine rI11. a017
S ature of Home Owner or nt Date
'Effective July 1,2004,a County Tax Oeoamrenf Morino Peeled must be provided before a Set Up Permit will be issued. It is
purchased from dm lax office of the county that the home is moved from. If the name 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.
o4n 1
SETUP
A PLAIN LANGUAGE C �
PURCHASE AGREEMENT C 'IENTURES HOUSING WIUR \YL/ ' 2 ,/
93 4E-41‘41,14t Ilt., 7
525 Raleigh Road Henderson N.C. DemBRI. 1I
252-992-0119 Fax_.252-492-0110 A T l ux1.a
r.
S. McCoy and Edward J. McCoy 491-7357 r11hO2-201Y
""Phyllis
AO0�1107 Greenway Drive High Point N.C. 27262 WW A Currin
in a:aema rute,a.t Mat m Weer loft Me re CAw,rr Spiro remam.1w St fl( t 41 Qua.
SEWS lo tie ems anrm,Wosa,eanaru Cl*P apses+you psi e W aid I lett a puida tt beAe e.Rr]uric
wAera.aaeyralcwood TEAR t ROOM FLOOR SIZEST CMAm
e
1997 . 3 L 76 ITE 14 L.8�w 14 215.
X10 0331234911 NEW $O USED IcaRRWhite IPROPOSED 0A1071Y "�°
DATE 'CE'"
LOCATION R-VALUE THICKNESS TYPE OF INSULATION mew ow mu $ 18,900 00
CEILING _OPTIONµf0UFHFM
EXTERIOR
FLOORS SUE-TOTAL A
THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND
IS DISCLOSED INCOMPLIANCE WITH THE FEDERAL TRADE COMMISSION RULE SALES TAX 448 1)0
:ACRE SECTION 460.16.
OPTIONAL EQUIPMENT,LABOR AND ACCESSORIES NON-TAXABLE RENS -
S Ie VAWOUSFEES AND OISAHNCE
The Manufactured Home is conveyed
"As TS" No Warranties whether-- 1.CASNPRCE .19..".
expressed or implied,are -made. to - mAOE I NAIfOw a $
the ;Condition of the :manufactured . iseseu_eleomiaove $
home for any purpose or use NETAUDWANGE . f
whatsoever or as to any other CASHION.:PAYMENT 1,000 UO
matter-whatsoever- except as spec- CASH sa
. AE®IS aMASI $
ifically set forthherein.
SUBTOTAL 5.'
. cAIFCTAXJWPS4-CI. 1Abae!
I.UrwsMfe4rntelat4.HetsPdos TH,i4d,. 60:.
EFFECTIVE OCTOBER 11, 2003
- I UNDERSTAND THAT I HAVE THE RIGHT TO CANCEL, IS
PURCHASE BEFORE MIDNIGHT OF THE THIRD{LIASR S
DAY AFTER THE DATE THAT I HAVE SIGN71118'+. ,
MEM 1 UNDERSTAND THAT THIS CANCF11AEDT1 - , ;
•
BE IN WRITING.IF I CANCEL THE PI1fiC4HASE
THREE-DAY PERIOD, I UNDERSTAND THAT THE Tu#AIER •
MAY NOT HAVE ANY OBLIGATION TO GIVE ME 9AA1(ALi
- OF THE MONEY I HAVE PAID THE DEALER.HINDERS94Np
ANY CHANGE TO THE TERMS OF THE PURCHASEgGHW-
MENT BY THE DEALER WILL CANCEL THIS AGREEMENT.
Remarks: I authorize VenturesESTIMATED RATE OF FINANCING 0 %
Housing Center to use my Escrow NUMHEH OF YEARS
Funds for this project
MONTHLYPAYMENTS
BALANCE CARRIED TO OPTIONAL EQUIPMENT S
DESCRIPTION?TRADE* VOIR -.
mAXEM OEL • BEDROOMS Svc x This agreement contains the entire understanding ndi hehrato."Ptya ii�id
COCOA SERIAL e0 71/IFNOme and no otherrepteeentitiou or indecentent,verbal Yr.disn.
AAouvrowws TO w,na hes been made which Is not curpdned in IN.centred-
TRAnF-IN OFRT TO RF PAID BYO DFM FR Q RIIYFR I OR WE, ACKNOWLEDGE RECEIPT OF A COPY OF THIS ORDER
AND THAT 1,OR WE,HAVE READ AND UNDERSTAND THE BACK OF
THIS AGREEMENT.
Ventures Housing Center DEALER SXGNEO.X aural
NH YAW Unitas S nd and BOA¢tsd by an 0161-,a me CsnPenv WL SECURITY MO
SIGNED BUYER
L J�I 11 A 2n
'1, 7^- SOCIAL REgREN...0
BY
tido 'Samoa arew,.ee.aMonona evbank or Bram canon,