SETUP/PERMIT/RECEIPT Application# 17—500 1"lg.(861 a
Harnett County Central Permitting
PO Box 65 Lillington, NC 27546
Telephone Number: 910-893-7525 Fax 910-893-2793 www.harnelt.org/permits
Application for Manufactured Home Set-Up Permit
(Please fill out each part completely)
Part I-Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
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Name:c� �Iprt��QQC-
\ ,ul2.. lt7 Address: 11% Le. l.etlrw'Yki A h_Q,
CityFAIct kka t \ State: Ni. LZip:AISC6 Daytime Phone: ( )5--41.12 7
Landowner Information (To be completed by landowner, if different than above) el
Q4 Poi
Name::Okij&Q .46.emGafxf
vl Address: L-ril L. 1Q T
City: bend f_cx4.1. 1 State: NL Zi4160S Daytime Phone: ( )QR1-,158-5538'
Part II-Contractor Information(To be completed by Contractors or Homeowner,if applicable.
Name,address &phone mus tch informatirnolice sep )
A. Set-Up Contractor Company Name: tins]an +` 5
PhoneP(IC1-115-3fooO Address:.%a)-S RC C'4,t�(,\ SI 4b
City: .tevri State: N.C Zip: 7 -( 2iat.?
State Lice 'JL\OO Email: n\ / A
B. Electrical Contractor Company Name:(bv t bt\ G6n-bail e
Phone:145^af.2-'7 trl.C1 Address: 11 Fi' Lei Cor-A-Iir i Lr ne
City:pvcCVr 01:444 State: N C Zip:gCI S 05
State Lic# Set.F Email: rr�Q/A
C. Mechanical Contractor Company Name:S ,kir1.1nc\ C(`.�Dn_ rI/oko Z
Phone:
€aba-1 to I.QS Address:t-1 R l
1 Se v^4- 1—k 41
City: Xr r6.Cal Li State: S` I(- Zip: 121505
State Lic#°?2\F Email: rJ1��,�.IA1_^
D. Plumbing
rContractor
�Company Name: (-(1U 1 f P 1 (icry ci PZ- . . r1
Phone:SOI "3106.- 1(QIDAAddress: 1i$ Le- Gt.vl'A.\ W�4.
City: State: Zip:
State Lic# Email:
Part III-Manufactured Home information
Model Year: (rig Size:)4 X I v Complete&follow zoning criteria sheet
Park Name: I(S b 4 L t .,,-1d Lot Number:
I hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
informn and have o• .'red their permission to purchase these permits on their behalf, and that the construction or
install will conf• m to the .•plicable manufactured home set-up requirements, and the Harnett County Zoning
Ordin: . I unde -land that i .ny item is incorrect or false Information has been provided that this permit could be
revo:1
,1
w !n:"rre: ome0 ra!'nr ._ Date
•
-Effective July 1,2004, a County Tax Department Movinc Permit must be provided before a Set Up Permit will be issued. II 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
DBA COUNTRY FAIR HOMES V
3331 NC S7 Highway S.
SNIPORD, NORTH CAROIJNl 27332
/� ` (919) 75-3600 • Pet (119) 775-7599 q ��c., �!
Burewsll �C',i 1\,Vii\ (—Y'• `1ri`C.I.Z- __- i `a(ooT�(n�nC{ I` I �acilL 1 .._
- 1 SALESPERSON
0
ntmsAL1 _ _. ER
MAKES MODEL I YEAR BEDROOMS j FLOOR SIZE r- HITCH SIZE STOCI(NUMSE
1R4�! 3 to IW14 L IRI.__
SERIAL NUMBER _-. �,,r I .
COLOR PROPOSED DELIVERY DATE KEY NUMBERS
❑ NEW /N USED? 1
LOCATION R VALUEITHICKNESS TYP�/OF�INSULATION BASE PRICE OF UNIT _I , C) r-2)
__
CEILING _ OPTIONAL EQUIPMENT
EXTERIOR --I-- •__-. __— �
FLOORS I I _ . _ _ _ SUB-TOTAL
THIS INSULATION INFORMATION WAS FURNISHED BY THE MANUFACTURER AND
IS DISCLOSED IN COMPLIANCE WITH THE FEDERAL TRADE COMMISSION RULE SALES TAX _.
I6CFR SECTION 460.16. - I
OPTIONAL EQUIPMENT,LABOR AND ACCESSORIES NON-TAXABLE ITEMS
$ VARIOUS FEES AND INSURANCE
CASH PURCHASE PRICE
1 �j
,\__\..c..0±:„? _)1d C
__ __ TRADE IN ALLOWANCE $
-}{ � LESS BAL.DUE on above$
1 z- -_- -__. _. I
c7- ___ � NET ALLOWANCE__ E
--�- - CASH DOWN PAYMENT -(')
CASH AS AGREED $ 11
f "1 _- - _ LESS TOTAL CREDITS •
`—-. C( -t `\ (r'P-0-2--V _. 1 _ __ SUB-TOTAL $
SALES TAX(If Not Included Above)
_ I . Unpaid Balance of Cash Sale Price s; .1(X) CT)
—C--5—V-::)-\r'-c___ - - Dealer and Buyer certify that the ad. anal terms and
conditi-- - —__ __. - _
�- Dopler na rinted on the other sided this Agreeare
---..: . agreed to as a part of this Agreement,the same as Sedated
i - __._.. ._ . above the signatures. Buyer is purchasing the above
_-. 1 �/�.. _._ deathbed manufactured home; the optional equipment and
C� 14- P �__ ___ j_— accessories,the imurance as descdbed has been voluntary;that
J ' C-' � Be?.uytrade-in Is free from all claims whatsoever, except
__. - - I -- as noted.
Lit
- ESTIMATED RATE OF FINANCING I ( ) %
_ -
---- -__ NUMBER OF YEARS Z_ ( V )
* -1
C
- -- - - - - ESTIMATED MONTHLY PAYMENTS S �-II fQ. 9,.- --
------ _-_- - - --- - - -- THIS AGREEMENT CONTAINS THE ENTRE UNDERSTANDING BETWEEN
� DEALER AND BUYER AND NO OTHER REPRESENTATION OR
_ _ INDUCEMENT,VERBAL OR WRITTEN,HAS BEEN MADE WHICH IS NOT
F. COVERED IN NO AGREEMENT.
F. BMWS)HAW EDGE
RECEIPT VICEREF AINE)
COPY OF BACK OF ORDER ANDBNT.
_ '. BUYBg3)IWVE REI1D AND iMDEHSTAID TE BACK OF 1H8 AGREEMENT.
j - I UNDERSTAND THAT I HAVE THE RIGHT TO CANCEL
THIS PURCHASE BEFORE MIDNIGHT OF THE THIRD
BALANCE CARRIED TO oPlIONAL EQUIPMENT T. BUSINESS DAY AFTER THE DATE THAT I HAVE SIGNED
NOTE WARRANTY AND EXCLUSIONS AND LIMITATIONS OF DAMAGES ON THE REVERSE SIDE. THIS AGREEMENT. I UNDERSTAND THAT THIS
DESCRIPTION OF TRADEN YEAR SIZE CANCELLATION MUST BE IN WRITING IF I CANCEL
THE PURCHASE AFTER THE.THREE DAY PERIOD, I
MAKE MODEL BEDROOMS UNDERSTAND THAT THE DEALER MAY NOT HAVE
--- - _--- ---- --- ------ -- ANY OBLIGATION TO GIVE ME BACK ALL OF THE
MLE NO. SERIAL No. COLOR MONEY THAT I PMD THE DEALER. I UNDERSTAND
AMOUNT OWING TO WHOM Y 0 T 1 ,, GF
AGREEMENT BY THH DEALER WILL CANCEL THIS
ANY DEBT BUYEROVIES ONTRADEIN IS TO BE PAID BY CI DEALER BUYER AG I I { //'' I
J WORN ES WC DBE kited slGRee�f i�SL L `(�YV\ BJV€R
NN ValbU end.AMplod IN IN r Company Aft n[ed ApeM DEALER SOCIAL SECURI NO ,t I'S
SIGNED% . . BUYER
Approved BY __ _,..a....„,.. --"C / --– ..SO.CyIAyLSECURITr NO _ _ __J_ I
O�6CONe ID IN LANG CHASE AGREEMENT CopY,1ln C1ee7 JENKINS BUSINESS FORMS•800,461-4424 Rae 6/14
DUPLICATE
HARNETT COUNTY CENTRAL PERMITTING
P.O. BOX 65
LILLINGTON, NC 27546
For Inspections Call: (910) 893-7525 Fax: (910) 893-2793
Application Number 17-50042872 Date 7/12/18
Property Address 24526 NC 24-27
PARCEL NUMBER 09-9566- - -0160- - -
Application type description CP MANUFACTURED HOME RA2OR/RA2OM CRITERI
Subdivision Name
Property Zoning PENDING
Owner Contractor
PATTERSON CLYDE L & OWNER
MANGUM DOUGLAS WAYNE &
4271 LEAFLET CHURCH RD
BROADWAY NC 27505
(919) 893-4628
Applicant
GONZALEZ GLARIBEL
178 LEE COUNTY LINE RD
BROADWAY NC 27505
(325) 262-7669
--- Structure Information 000 000 14X70 2BDR SWMH
Flood Zone FLOOD ZONE X
Other struct info # BATHS 2
# BEDROOMS 2000000 . 00
MOBILE HOME YEAR 1000000 . 00
PROPOSED USE SMMH
SEPTIC - EXISTING? NEW TANK
WATER SUPPLY COUNTY
Permit LAND USE PERMIT
Additional desc
Phone Access Code 1251248
Issue Date . . . 7/12/18 Valuation . . . . 0
Expiration Date . 1/08/19
Permit MANFACTURED HOME PERMIT
Additional desc .
Phone Access Code 1251230
Issue Date . . . 7/12/18 Valuation . . . . 0
Expiration Date . 7/12/19
Special Notes and Comments
T/S: 12/06/2017 12 :40 PM JBROCK ----
TAKE 27 HWY GO APPROX 15 MILES R ON
24/27 HWY GO APPROX 6 MILES PASS WATER
TANK PROPERTY IS ON THE RIGHT
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 17-50042872 Date 7/12/18
Property Address 24526 NC 24-27
PARCEL NUMBER . 09-9566- - -0160- - -
Application description . CP MANUFACTURED HOME RA20R/RA20M CRITERI
Subdivision Name
Property Zoning PENDING
Required Inspections
Phone Insp
Seq Insp# Code Description Initials Date
Permit type . . . . LAND USE PERMIT
999 818 Z818 PZ*ZONING INSPECTION / /
999 820 Z820 PZ*ZONING/FINAL INSPECTION / /
Permit type . . . . MANFACTURED 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 CUUt_Y CASs. RECEP='TS
♦1* CUSTOMER RECEIPT +**
Uper: 3DROCK Type: CP Drawer:
Date: 7/1E/16 56 Receipt no: 16141
Year Nuacer Amount
2017 50042072
4526 NC 24-27
CAMERON, NC 20325
D1 BP - PERMIT REFS 4175.00
RC-NEWSIEST
RAVES ROCK
Tender detail ;175.00
CP CREDIT CARD 5175.00
Total teoiiered 4175.00
Total payment
Trans date: 7/1E116 Time: 13:26:51
** THANK YOU FOR YOUR PAYMENT x.