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SETUP/PERMIT/RECEIPT plication I 4 ac Harnett County Central Perrmitting & , -� , `� on, NC 27546 Telephone Number: 910-893-7525 FPO Box 65 ax 910-893-2793 www.harnett.org/permits Applica ion for Manufactured Home Set U Permit (Please fill out each part completely) Part I-Owner Information: Home • er Information(To be completed by owner of the manufactured home) 1 ^ Name: Ilk ill s \ Adtlress1y�li �h �1a u l : City:li✓ _ State: _.Zia3Slib (n 1 T`�". P Daytime Phone: - Landowner Information (To be completed by landowner, if different than above) Name: Address: City: ________________State: Zip: Daytime Phone:( ) Part 11-Contractor Information (To be completed by Contractors or Homeowner, if applicable. Name,addre:..&phone li t match informati.n on icense A. Set-Up Contractor Company Name: 41, -i Phone- (_42 — �'� • G� � Address: L i City: ,Y QFC � - �_ �./l _ State:_____I\,)_cZip:^11 State Lic# 34 O/ ) Email. A B. Electrical Contractor Company Nam S/'� P Y -•sweat � • V PhoncEQec21 -/.-.!`K2 Address: �R.� City: . .w` .. State: — - . Zip: d�ZC- State Licit _ Email: C. Mechanical Contract. o pany Name: - a Phon-et!- A. Address: hire' ._ya �' rag City: , A'� A 1 Slate: '''may l� �j Zip, �Sf�� , State Lic# ��VIV Email:_ gis D. Plumbing Contractor Compaq)?Name,-LIea-� C c{ Phoral-353-1111. t„u 0..A AR LS O�..• A I Cityg(� � dress r� ,acni C 2 d3state: k 1 �A Zip. • : • State Lic# �'� _ Email:_ la b+ Part III-Manufactured Home Information Model Yea _SizCZmaComplete&follow zoning`cfriteria sheet ,4 Park Name: S- •-• Si Lot Number: __-1 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 inslallation will conform to the applicable manufactured home set-up requirements, and the Hamett County Zoning Ordinan underst an incorrect or false information has been provided that this permit could be r-yoked A . a r^ Sr.nature •It. o i owner m �gent Date 'EffectiveJuly 1,2004,a County Tax Dep q e t Movin 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 it available, the serial number List of inspections and Egress requirements available upon request Progress Energy customers must provide Premise Number SETUP 04/11 E. J. WOMACK ENTERPRISES INC. DBA COUNTRY FAIR HOMES 3335 NC 87 Highway S. SANFORD. NORTH CAROLINA 27332 yQyy�{ ��^-1 p ` (919) 775-3600 • Fax: (919) 775-75333�_�I�('') (//��1r [^'�1 1�'1r l trc c\ ��\ Cr_ panic) R N IL/�L-6273LI DATIa R ` J tt \ YN. l� Lt vclw 1\t'C, oIR SCD 1 B"` °"&i nick .111 Euv[ ADDREI c �� —\ `N�^ /1«ritS MAK &MODEL `J YEAR BEDRJOMS ,'LOON SIZE ETCH SIZE STOCK NUMBER -lien C 0.V D \. e.v 2tea 3 1.56:w./KS;. wN AEER�IIALL NUMBE �5'231 �7 COLOR PROPOSE()DELIVERY DATE KEY NUMBERS C jG2 SCA/�7 1 N 0 A 5 AEW Li USED LOCATION R-VALUE THICKNESS TYPE OF INSULATION BASE PRICE OF UNIT lee L1W-1 CEILING OPTIONAL EQUIPMENT EXTERIOR • __ ,�T•n FLOORS SUB-TOTAL $ a�I�_I 1 THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND Y•ar I 1 IS DISCLOSED IN COMPLIANCE WITH IHE FEDERAL TRADE COMMISSION RULE SALES TAX 225 ( 16CFR SECTION 460.16, _ OPTIONAL EQUIPMENT,LABOR AND ACCESSORIES NON-TAXABLE ITEMS ktjt(r"1 4- e1/4 Lc $ VARIOUS FEES AND INSURANCE i Co � CASH PURCHASE PRICE LESSE-IN BAL. DUE an above$ � �7 27 CASH DOWN PAYMENT �S I •' ; {alt vinbw� t -C$ mOtO / / i2 CASH AS AGREED 1$ /./, LESS TOTAL CREDITS IS CVO QC_ T--oLw•�t-inCXn SUB-TOTAL 'S q^ SALES TAX(I1 Not bmluded Above) a, xI BF ''I Unpaid Balance of Cash Sale Price S �' as Dealer and Buyer certify that the additioa arms and conditions printed on the other side of this Agreement are agreed to as a part of this Agreement, the same as if printed above the signatures. Buyer is purchasing the above described manufactured home; the optional equipment and accessories,the insurance as described has been voluntary;that Buyer's trade-in is free from all claims whatsoever, except as noted. ESTIMATED RATE OF FINANCING Via NUMBER OF YEARS ESTIMATED MONTHLY PAYMENTS$ THIS AGREEMENT CONTAINS THE ENTIRE UNDERSTANDING BETWEEN DEALER AND BUYER AND NO OTHER REPRESENTATION OR INDUCEMENT,VERBAL OR WRITTEN, HAS BEEN MADE WHICH IS NOT COVERED IN THIS AGREEMENT. BUYER(S)ACKNOWI Fla RECEIPT OF A COPY OF THIS ORDER AND THAT BUYER(S)HAVE READ AND UNDERSTAND THE BACK OF THIS AGREEMENT. I UNDERSTAND THAT I HAVE THE RIGHT TO CANCEL THIS PURCHASE BEFORE MIDNIGHT OF THE THIRD BALANCE CARRIED TO OPTIONAL EQUIPMENT $ BUSINESS DAY AFTER THE DATE THAT I HAVE SIGNED THIS AGREEMENT. I UNDERSTAND THAT THIS orerRIpTON Or TRADAIN YEAR Svc CANCELLATION MUST BE IN WRITING IF I CANCEL THE PURCHASE AFTER THE THREE DAY PERIOD, I MAKL MO_.,. BEDROOMS UNDERSTAND THAT THE DEALER MAY NOT HAVE rnlE NO _. ANY OBLIGATION TO GIVE ME BACK ALL OF THE .u,l NO MONEY THAT I PAID THE DEALER. I UNDERSTAND AMOJM OWINL,10 AMOR ANY CHANGE TO THE TERMS OF THE PURCHASE AGREEMENT BY THE DEALER WILL CANCEL THIS ANY DEBT BUYER OWES ON TRADE-IN IS TO REPAID BY DEALER BUYER AGREEMENT /NQ LrAe E. J. WOMACK ENTERPRISES INC. SIGNEIx GIN/' s , 6L�f�� BUYER DBA COUNTRY FAIR HOMES /L Nor Vold Umoss Signed nod Arneplea by x„Omoor of roe Company o,onARAN/Needn ;eed ageII DEETII SOCIAL SECURITY NO Z;.� fo I a �O4 SIGNED% Approved By I{/ SOCIAL.SECURITY NO. OR e A PLAIN LANGUAGE PURCHASE AGREEMENT Y o yronI aa983 JENKINS BUSINESS FORMS•eWES,-01424 Rev 004 BUYER HARNETT COUNTY CENTRAL PERMITTING P.O. BOX 65 LILLINGTON, NC 27546 For Inspections Call : (910) 893-7525 Fax: (910) 893-2793 Application Number 17-50042998 Date 3/05/18 Property Address 973 BUIE RD PARCEL NUMBER 03-9598- - -0008- -07- Application type description CP MANUFACTURED HOME RA20R/RA20M CRITERI Subdivision Name Property Zoning RES/AGRI DIST - RA-20R Owner Contractor RAY JOHNNY C RAVEN ROCK MOBILE HOME MOVER 446 BILL SHAW RD 3335 NC 87 HWY. SPRING LAKE NC 28390 SANFORD NC 27332 (919) 775-3600 Applicant WILKES RICHARD 1451 OVERHILLS RD LINDEN NC 28356 (910) 709-6734 --- Structure Information 000 000 26X56 DWMH 3BDR 2BTH Flood Zone FLOOD ZONE X Other struct info # BATHS 2 # BEDROOMS 3 . 00 MOBILE HOME YEAR 2017 . 00 PROPOSED USE SFD SEPTIC - EXISTING? NEW WATER SUPPLY COUNTY Permit MANUFACTURED HOME PERMIT Additional desc . Phone Access Code 1232131 Issue Date . . 3/05/18 Valuation . . . . 0 Expiration Date . 3/05/19 Permit LAND USE PERMIT Additional desc . Phone Access Code 1232123 Issue Date . . . 3/05/18 Valuation . . . . 0 Expiration Date . 9/01/18 Special Notes and Comments T/S: 12/28/2017 09 : 29 AM LLUCAS ---- BUIE RD TAKE HWY 27 W TOWARD SANFORD & WESTERN HARNETT HIGH SCHOOL - IT WILL BE ON THE LEFT AFTER YOU SEE THE HIGH SCHOOL - HARNETT COUNTY CENTRAL PERMITTING P.O. BOX 65 LILLINGTON, NC 27546 For Inspections Call : (910) 893-7525 Fax: (910) 893-2793 Page 2 Application Number 17-50042998 Date 3/05/18 Special Notes and Comments TAKE THE NEXT RIGHT ONTO BUIE RD - PROPERTY LOCATED ON THE LEFT AFTER CROSSING THE BRIDGE - 1RST DIRT RD TO LEFT WILL GIVE ACCESS TO THE PROPERTY HARNETT COUNTY CENTRAL PERMITTING P.O. BOX 65 LILLINGTON, NC 27546 For Inspections Call : (910) 893-7525 Fax: (910) 893-2793 Page 3 Application Number 17-50042998 Date 3/05/18 Property Address 973 BUIE RD PARCEL NUMBER . 03-9598- - -0008- -07- Application description . CP MANUFACTURED HOME RA20R/RA20M CRITERI Subdivision Name Property Zoning RES/AGRI DIST - RA-20R Required Inspections Phone Insp Seq Insp# Code Description Initials Date Permit type . . . . MANUFACTURED HOME PERMIT 10 501 T501 R*MOBILE HOME FOUND. / M. WALL / / 10 814 A814 ADDRESS CONFIRMATION / / 20 818 Z818 PZ*ZONING INSPECTION / / 30 507 T507 R*MANUFACTURED HOME FINAL / / 999 H824 ENVIR. OPERATIONS PERMIT / / 999 H828 ENVIRO. WELL PERMIT / 999 307 P307 R*PLUMB WATER CONNECTION / / HARNETT COUNTY CASH RECEIPTS oma CUSTOMER RECEIPT a♦a °per: JBROCK Type: CP Drawer: 1 Date: 3/85/18 52 Receipt no: 272850 Year Number Amount 2017 50042998 973 BUIE RD BROADWAY, NC 27505 B1 BP - PERMIT FEES DON $225.00 EJ WOMACK Tender detail CP CREDIT CARD $225.08 Total tendered $225.00 Total payment $225.00 Trans date: 3/05/18 Time: 9:45:51 ** THANK YOU FOR YOUR PAYMENT ar