SETUP/PERMIT Application M `-'1 -a Log LI
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnett.org/permits
Aoolication for Manufactured Home Set-Uo Permit
(Please all out each part completely)
Pan I-Owner Information:
Home Owner Information(To be completed by owner of the manufactured home)
Name: Ph y no' s' dirt 111 eCo Address: lit? Green y br, ve.
Cay: Ni/A l Pr;e I- State: A!C- Zip: -17ak a- Daytime Phone:( ) 314 49/- 7,357
Landowner Information (To be completed by landowner,if different than above)
Name: P,1( j1/i5 /8 toy Address: no) .ireerl wci Dr/✓c°
city: /1 h /2IA± State: n!C zip:-27a6 a Daytime Phone:( ) 3.46- qy,- 7,457
Part II-Contractor Information(To be completed by Contractors or Homeowner,it applicable.
Name,address,a phpne must match information on license)
A. Set-Up Contractor Company Name: Eat M /1 11106,t- Nome Mt .'e es
Phone: -7.54- a 30-0810 Address: .20 5 B&A n leoq d
City: ken ly State: N(' Zip: c ] EN'S
State Lica 3532 Email: t1C+tron /rdim& ao/. Com
B. Electrical Contractor Company Name: Pn .e r alas-ber/� file c#n c /M .
Phone: 4/0- 5S9- 441/ Address: 7/o a / Purn y Pd. Ste /0/
City: tut ay f State: A) C Zip: 2TSa /c
State Lica 14673 -0 Email: bmurjnn ,for ranks-kreler -trlc . CO/n
C. Mechanical Contractor Company Name: Soh i7 /{Ca4 - Al Seri re,/ rile ,
Phone:r'/o — Y93-8057 Address: P. II , ROX 737 t
City: 13uie5 (-reek State: Al O. Zip: c27506
State Lica 2 03 &0 Email:
D. Plumbing Contractor Company Name: 4u e ry Plu m h i nq
Phone: l9 -629-?223 Address: 32:J/ Pian V;ew Church Rcad
City: 14-All; r State: AI L Zip: -2750/
State Lica I0 y766 — P Email:
Part ill-Manufactured Home Information
Model Year: MP/ Size: Al x 10 Complete& follow zoning criteria sheet
Park Name:
RQ I ek Rivera Rk& PNP Lot Number: #i3 (66 Rendeescn J>r.)
I hereby cagily 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.
e Nod. c2011
Signature of Home Owner or Aggsnt Date
'Effective July 1,2004,a County Tax Deoadment 4 vino Penni(must be provided before a Set Up Permit will be issued. !Hs
purchased from the tax office of the county that the home is moved fromlI 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 PAIN LANGUAGE IIIM
PURCHASE AGREEMENT VENTURES muses awns 0 1.) ,J i J
525 Raleigh Road Henderson N.C. ,/ 1 1 f��
252-492-0119 Fax. 252-492-0110 APON�aIp! ^v14 n;,s-„ ii./hi C
11".(61Phyllis S. McCoy and Edward J. McCoy M91-7357 02-2017 77
"P01E5s1107 Greenway Drive High Point N.C. 27262 SALESPERSON in s"cl
In GM wen N is lamameag nl.bne Mow and roag.4+v Pe.Mew II. eaatIs,-b m PIMA
SNlpb a,MbbbnY4em b.se S wont 1a yabMeel R to a.ea"is McC,sr,4 Ye
MMIEIal-Oakwood YEN BEwai L aDPxs� wipe Sff smsxas el
# 1994 3 166_Iw. 14 £70 1w 14 213
IF0NC77014CK3701708 0 NEW )13 DEED la"�Jhite PROPOSED 0EMERYDOE KEY WOMB
LOCATION R-VALUE THICKNESS TYPE OF INSULATION PRICE OF UNIT $ 18.900 00
CEILING One*EDIAPAINT
EXTERIOR
FLOORS SUB-TOTAL
THIS INSULATION WFORMA TION WAS FURNISHED BY THE MANUFACTURER AND
IS DISCLOSED IN COMPL LANCE WM4 THE FEDERAL TRADECMMIISSION RULE SUES TAX 448 OU
*GRP.SECTION 460.16.
OPTIONAL EQUIPMENT,LABOR AND ACCESSORIES AOMTAXABIEITB6
S ba VAN=FEES AND IMS/1AMGE
The MA pufactared Home is conveve9
As -IS No Warranties whether . 1.CASNPRICE .. _..J1£ ,
expressed or implied;are made to . . PsaAudeexE $
the condition of the -manufactured . mr,Nasaa.aIEIMOWE $
home for any purpose or UseAIETALLOWANCE
whatsoever, or as to any other - fwSNmNNPA) T 1,000 OU
matter whatsoever except as - spec- - CAw1ASAw®F*RIIGN $
ifically set forth herein. 2 t& TOTALG DlTS i .
SIIAbovTAL.
SALESleshmo OMSilMaudeAbove)
3.Ikw.IdB lwlasd4stlMgp $ ltl{34gs; LA0.
EFFECTIVE OCTOBER 11, 200.9 .
•
I UNDERSTAND THAT I HAVE THE RIGHT TO CANGELIHIS
PURCHASE BEFORE MIDNIGHT OF THE THIRD BUSINESS
DAY T. I AFTER THE DATE THAT HAVE SIGNED THIS'TU11
D I UNDERSTAND ATED THAT THIS SIGNED NN
BE IN WRITING. IF I CANCEL THE PURCHASE(FT 'it
THREE-DAY PERIOD, I UNDERSTAND THAT T E J*AIER
MAY NOT HAVE ANY OBLIGATION TO GIVE ME BASK ALL
OF THE MONEY I HAVE PAID THE DEALER.I LMDEIN1ANp
ANY CHANGE TO THE TERMS OF THE PURCHASE:gOFiff-
MENT BY THE DEALER WILL CANCEL THIS AGREMAENT.
lima I authorize Ventures ESTIMATED RATE OF FINANCING 0 %
Bono ing Center to use my Escrow NUMBER OF YEARS
Funds for this prosect
MONTHLY PAYMENT=
BALANCE CARREDTO OPTIONAL EQUIPMENT S
PFiaVrW r7M -#i YEAR
COLOR SERIAL NO nneevaoaas aux This r casino Ma entire PnOSTmmgW 441w«a Y0.1>wd
npnasn- -or Inducement.rebel a awlNrl.
AMOUNT OMMI TO m.o., has berg made shish Is notrgmhbd In the dow6ad. '
TRADE-IN OFRT TO RF PAID AVO OFAI FR 0 q1/YFR 1 OR WE ACIOVOWlE1JOE RECEIPT OF A COPY OF THIS ORDER
AND THAT I,OR WE,HAVE HEAD AND UNDERSTAND THE BACK OF
THIS AGREEMENT
Ventures Housing Center ()BOER SIGNED BUYER
Ib VK14wb So/Was AaaSJ even Cate N At CMrynr
Eat.9fiY.MYMa
1 i --i SIGEDx BUM!
a Iit- /�/�� soausaulrrrw.
1105 Y4�eanV MlryMie0Y0,M uiwm roaeM