SET UP 1.1 APplleatlon # / S p9 2 ✓ VV
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 -Up Permit
(Please fill out each part completely)
Part 1 -Owner Information:
Home Owner Information (To be completed by owner of the manufactured home)
Name: On. y ✓'r> // Address: SS 6J�r,n rLs'P Rd
City: // }r /lnO ,s nj State: /1/"C Zip: a Daytime Phone: ( ) 9/9 -/Y93
Landowner Information (To be completed by landowner, if different than above)
Name: Address:
City: h /er State: Zip: OZYsb/ Daytime Phone: ( ) 9/9 --3r- /893
Part II Information (To be completed by Contractors or Homeowner, if applicable.
Name, address, & phone must match information on license)
A. Set -Up Contractor Company Name: SAP, '1'11114 C Y11 0V 2i25
Phone: 1C1- LIZZ- `�Io.2.3 Address: .1M6 A A 0 u i(l(1 Rt.
City: 'R \n1`1 S t te: (1� Zip. at15nL!
Setup Signature: 2j U�r�r -� State Lic# Z��9
B. Electrical Contractor Company Name: \rc'oU [jYl - ens 1.
Phone: q1 n- `1KO -I bit ( Address: ICI 1 1:CP(k M ni f ( F,
City: A . ate: ! ip: 7 75c
Electrician's Sianatu : ::— J r: i State Lic# c.:12I /739
C. Mechanical Contra • r Company Name: mom( k or M ei
Phone: etn 4 Address: O .a \ *fat VJL
City: 1 - 1' St- _: ne Zip: e' '1 5t
HVAC Si.nat re'. _to a / _est State Lic# /(975t) P3
D. Plumbing Contractor Name: i , 11 • 1 I
Phone: l tQ-1p. Q-#72Ch Address: .0. ' ,' c? S " 4
City: \1� n 1 Stat:' i C Zip: a1a.5 r(�
7 Z
' ""' S
PI mb:r's ten- re: i�.... _' State Lic# 1� 5 O
/ 1
Part III - Manufactured Home Information
Model Year: )007 Size: 3 jx Co Complete & follow zoning crlteerle sheet
FievName: /Ay inn) /, nh•& 4 /t9it »MeNumber: ?V - 819- - CVO &
1 hereby certify that I have the authority to apply for this permit, that the application is correct including the contractor
information and signatures, 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.
Signature of Home Owner or Agent 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 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 4/08
SALES AGREEME , 115 2 C ! I
CUSTOMER NO.: DATE; /a' / 3
? `/
BUYER(s):: � eAtaiyn R fiAtaoGI. SSN:
-
. /J)t uil 2 . 1.sa46LG SSN:
ADDRESS: 5.G g;iy 2d. w/&/4 .p411<i S. NC MMM6
DELIVERYADDRESSS: �7 �J� J�
TELEPHONE; 91 / U /' �(OI (O� SALES P ERSO N: 0/71"1'/1 L /fit
BASE PRICE: $ r efi Make: CA N Mod -.
Dealer Prep $ Y 'r4 .w Width• MI Stock #:
SUB - TOTAL $ 7 't'' Serial No.: fn(J -1' S . v P1 New • Used
Sales Tax S i.. 00 TRADE: Make: Model:
e F $ .'. a- Year: Length: Width; Title # :
` Eli t ` 5 S' an " SerialNo.:
sank r. , , s $ e ..i '' Amount owed will be paid by: ❑ Buyer ❑ Seller
$ t . ,
i.C .. $ a pj.e° Owed to:
Trade Allowance 5 OPTIONS:' r. l See � , I •M. =r .r .
Less Amount Owed $ 1, •'�Z,�: A/ gItil . f t A
Trade Equity 5 ` M6 .: . ... I ! ,717 To
Cash Down Payment $ ELLE • ' . PONSIBILrr ES: / !We L A!/
Other Payments $ , t - t t -. ..! nir t . •'' ' Pi f!! W ¢ L.
2. LESS ALL CREDITS $ • Si' ! a, 4 remora A . .' Aft . '- -A
3. REMAINING BALANCE $ //5 i nt e rrThiaie " ! 3 irrn '
Location R•Valae Thickness • of miation BUY RESPON ILmES: ' KM S
Ce11M: E�'arindai - M 45& . , I I Ds / a 4 .in W. 2 arairi7FSS 11.
Ener+a Haig cif. tT
Flews Etalli Cl e ,
Thy inndadwllflformaaonwaslhrnt - .... hey not men local codes and nandardr. Nor honesrant Federal Manstfietunrd Han Standards.
and U disclosed m eompllanee with the Federal Trade
Cammltsion lute 16CRF. Seethe 160.16. I UNDERSTAND THAT I NAVE THE RIGHT TO CANCEL TNIS PURCHASE BEFORE MIDNIGHT OF THE
ESTPMATED MORTDAGS Buyer is valwdaH(y purdha,N THIRD BUSINESS DAY AFTER THE DATE NAT I HAVE SIGNED THIS AGREEMENT. I UNDERSTAND
any Worms products fitted below. All numbers are THAT THIS CANCELLATION MUST BE IN WRITING. IF I CANCEL THE PURCHASE AFTER THE THREE
estimated DAY PERIOD, I UNDERSTAND THAT THE DEALER MAY NOT HAVE ANY ODUGAT1ON TO GIVE ME
A. OTHER CHARGES BACK ALL THE MONEY THAT I PAID THE DEALER. I UNDERSTAND ANY CHANGE OF THE TERMS OF
Property Insurance $ THE PURCHASE AGREEMENT BY THE DEALER WILL CANCEL THIS AGREEMENT.
113?? Insurance $ ESTIMATED RATE OF FINANCING: NIA % NUMBER OF YEARS: NULL
License Pees 5 ESTIMATED MONTHLY PAYMBTTS $ WA
$
.
$ Buyer(s) agree: (1) that the terms and conditions on page two are part of this
$ agreement (2) to purchase the above home including the options; (3) they
TOTAL 5 received and acknowledge receiving a completed copy of this agreanent; (4)
B. Unpaid RalAmt Fin. n•.1 S _ that all promises and representations made are listed on this agreement and (5)
C. Interest Rate % there are no other agreements, written or verbal, unless evidenced is writing and
D. Finance Charge $ si •,, by the parties.
F. Total of Payments ta+ek $ R •
F. Total Sales Price n+.•aI $
G. Number of Payments # ///. /r .
_/ . _/ � , . _�.�t
X � , /
H. Payment Amount $ �/
/ 1 i
X ° • .is 0 •
7*1, is not a loan commitment • nue
X
otstno
X
• Oatrewe&
Rev 10/2004 NC Sales Agreement CAN 1'
Z 'd L69 ' °N WdtS :Z LIOZ 1 'gad