SET UP •
( I Application# ii 5 74 24
Haman County Central Permltfng
PO Sox 85 UAington, NC 27548
• Telephone Number: 910.993 -7525 Fax 910 - 893 -2793 www.hamettorgfpermlts
• • , Acpdrretipn for Manufactured Home Setd/n Permit
(Please CI out each part completely)
Part I -Owner Information: •
Note Owner Information (To be completed by owner of the manufactured home)
h p
Nance: flr\rk 0 r.. rec.} 1 __ Address'
f �h �tl oe ( (4 P1 5.,. ? d Z'
City1 !„ - State: _II! 7 ?? Daytime Phone: p /,) 7 iv-4 - ii
Lani4owner Information (To be completed by landowner, If different than above)
Na l e: Tennis bi n'..
L c,cs _ AddreSB; %97 Cal haea Li
.Ctty' f• „ „'e State: rUe Zip: . Daytime Phone: V41 ,SL v /4 - 5 24/ J .
sd/J
Partjll - Centraolor IMormatlon (To be completed by Catactom or Homeowner, It applicable.
Name, address, 8 phone /mud match information on license)
A. 1 Set -Up Contractor Company Name; Cfl Nraa Serwlro
Phone: VP 71 Y - 9' 7 la — ,addr Ya5 p/fL -n
1 Cfty: dvrrb%t _ State: /VC Zip: 21,757 ' Setup Sionature; _ __ __ / r State Uc# 217 3
B. I Electrical Contractor Company Name; Brit— 1•1411A- 5-4
' Phone: 4 /p yt3- rer07 _ Address: 5lf1? /1ta4.11 4'
City: ' #•riclw _ State: A ZIp: a / -gyal
Electrlolawn Signature; e 2falprod -&J State uaR 0 1093Y -sfb
C. j Mechanical Cabtraotor Company Name; . :?/G Mtar' S.-ca
' I Phone: 9,b - Addreea: l' dou 93
l City: AMs0f4 / }�j _State: We. Zip: 28.3 / yt-o4 43
a )IVAC Sionature;__ c2)n .! ) State Ua#LDSN
D. Plumbing Contractor Company Name: AfcLm 1 .
. Phone: 9 /P- 6,7 -30 97 Address: AP. Bag 27/
1 City: ), vn,6r.,, _ State: ith -t.. Zip: 2 835`x' 271k fig l
.
1 plumber %Signature; Pitt. L /s? •
s n4..2 stateuc#JYD /`7_ 'L _ .
Part ID- Manufactured Home Information
Mode (( Year: • a x ,
41 Mae: zsz Complete & follow zoning oafer& sheet
• •
Park time: Lot Number.
•
I hereby certify that I have the authority to apply for Ihle perm, that the applladon Is correct Including the contractor '
Warman and signatures, and that the construction or Installation will conform to the applicable manufactured home
estop uequtremenls. and the Harriet County Zoning Ordinance. 1 understand that If any Item Is Incorrect or tales
information has been • • • ed that this permit could be revoked
i. AM ,C ` . 1) — i/
: , : of Home Owner or Agent Date
j 'Effective Jupt f, 2004, a Carty Tax Oenarfmsnt tkipvinq Pennll(muatbe provided before a Bet Up Permit will be Issued. It Is •
: purChaaed f r Jn the (tt orrice of the county (bat the .home Is moved from. 11 the home Is from a fir, we need proof of year an the
: t emato g The gavial 'lumbar.
Inspections and Egress regWe►rentg avafabb ion request. Progress Ener81r customers must provide Premise Number.
BETUP
4108
V Mar. 11. 2U11 1U:2 /AM No. 5491) N. 1
. &9LESAG.�EFIB�'NT .
3TOMERNO.; inn c 6 0 . . 1 ( 6
H A T S: 3- 7 - 1 i
YER(s):
SSN:
SSN;
)tea; S �� vi,/ vt.� (-t- -- .... } �� - 2:733 a
avBRYADDRESS: -
PPHONE: S -2•11 — / 0 6 V SALES PERSON: ,1u,.. — A wn a .
E PRICE: $.4.U.(24___ Make; 20 I I Modal p ! _._
lTt� $ U Year. N/A Len:. • . Wid • :- Stock* Ok /
$ c5 17 Serial No. •c. • 0264 IL
a Tax $ TRADE: Make - _ - _ _ r us d _
' Model;
a Fees
$ - 6 o u Y ear. Length: Width: Title #;
$ Lip Serial No.:
$ Amount owed will be paid by: 0 Buyer ❑ Seller
$ Owed to:
ASSPa1cE $..�� iq !J
le Allowance S t OPTIONS; .
1 Amount Owed $ •
•
le Equity $
1 Down Payment $ $EL= REBPONSIEU.ITIES; •
n Payments $
BSS ALL awns $
EMAI?ONG BALANCE $
Noe IGValuo Timmins Type ofTasuladon S0YEfRERPoN81n1LTnas
Mg
for
•
trs •
'mutation Gdommolon nemfiantshedbytheMamfaann r May normal local coderends:mdardr. New homes m at Federglhlmn�aenwedH
t disclosed M eompllmme with the hard Twat _
stsstonRutsMCRF. Seaton 46Qltx I UNDERSTAND THAT I HAVE THE RIGHT TO CANCEL THE; PURCHASE BEFORE MIDNIGHT OF THE
'MAmDMORrr+AGJZ MOW la volwua4tFunhas ' i THIRD angina DAY AFTER THE DATE THAT I HAVE SIGNED THIS AGREEMENT. I UNDERSTAND
nos+ wance products listed betow.BNmanbers ' THAT THIS CANCELLATION MUST BE IN WRITING.IFICANCELTHEPURCHASEAFTERTHETNREE-
ed DAY PERIOD, I UNDERSTAND THAT THE DEALER MAY NOT HAVE ANY OBLIGATION TO GIVE ME
� , + CHARGES BACK ALLTHE MONEYTHAT I PAID THE DEALER. I UNDERSTAND ANY CHANGE OF THE TERMS OF
'-, *.. • : co $ THE PURCHASEADREEMENTBY THE 0EALERWILLCANCELTHIBAOREEMBIT.
p . AZ " ee. $ it ESTIMATED RATE OF FDUwaNO: ' N/A % NUMBER DFYEARS: NULL
nseFe -5- $ E aTmmo MONTHLYPAYMENTS'• '
~1 '4, i f Buyer(s) a gree: (1) that the terms and cand4Hnrc on page two are gait of this
s. agreement; (2) to purchase the above home including the options; (3) they
received and aclmowledge receiving a completed copy ofthls agreement (4)'
npaid Bal/Amt 's - i that all promises and representations made are listed on this Agreement; and 0)
;Wrest Rate `, there are no other agreements, written or verbal, unless evidenced in writing ind
nano a :∎ '7 '' ! sr:, the . .. ea.
:.
otal of ' cuts teen ' ;. S te : Dom:
otal S. oe ($MDI ._
t u rn yments # .. \ i X ,
`e ntAmount $ "� '�'�
This Is not a loan commitment "' • t
X
X
• • pose) •
CMH
10/1004 NC Sales Agreement