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SET UP 03/15/2011 16:42 FAX 919 778 1981 ADCOCK APPRAISALS Inc 09/07/2011 14:16 FAX 819 778 1951 ADUUta AFC1CAleALe £11L Application# g APO 26 2 1 Harnett County Central Permitting Pb Box 65 Ullington, NC 27648 , Telephone Number: 910 -883 -7525 Fax 910. 883 -2783 www.harnett.org/pernits AnnBcation for Manufactured Home Set -Uo Perron (Pleasa fill out each part completely) • Part I -Owner Information: Home Owner Information (To be completed b ow of the manufactured home) Name: CI C- yen •Avy�Iy,r, f Ohri i riA rese• 5-'S WhHHcaa ;KS Zo4d p , City:,Ger i rl 1 i tiJ r state: &I C Zip: !°9 Daytime Phone: ( R/S a r�) - 3� '✓ l c.`Z Landowner Information (To be completed by landowner, 11 different than above) Name:_, San Le 4 a 1N i ale rd , Address; S.O. Pox 3367 City: Ranfrmri_ State: Wt 427331 Daytime Phone: (919- 774-9 Part 11- Contractor Information (ro be compiled by Contractors or Homeovmer, If apptr:able. Name, address, & phone must match Information on license - •. A. Set -Up Contractor Company Name: -a rvt .rvnteuat i4a C -., 'P. CO3 t e `G Phone: $ 26,•7S•6r. 4o771i Address: 'RA I+w r yozm.( s Cam: v%v-. fh i N K ••• r L(404, State:., r , Zlp: ?no o BetlmSicnature: . 6 +....' 711 a„n —'R State Lice WI Z� - B. Electrical Contra or Company Name: Sr.t a 1.0 S I war Phone: t7 /. • /.ZD •0O0 Address: A 0 Dos G fl City: whit % D IA-in c. State: A IC _ Zip: 2-7 f O • f�l slur Z G 331 — L_.. .. C. Mechanical Contracteflt r ' a 6reterill- ,8 9( 7 1.c7 6. 1r TSbry Rd, e V-10 , t_ 1, _ °., a ire iir; r�ylo r . 13. a u nIR61 g°ctor Company Name: PA,-nn r.1 P to u , et c - • tics" r 9 W"kakso( Phone: 13i • iv:-gS Address: 7 %q as.,so e, /n.it & • City: F ry Mate: � C� _ Zip: ?• - 7.07 0 ) , 2 nber's S icnature: ; ,Lit l r i.., y ., J, r State Ltc# a-1 h — P art Ui- Manufactured Home Information SO Model Year: i f Size: 14 X 80 Caters & follow zoning criteria Sheet P ark Name: 'Angola y+i 1 c.-.R1 sri al nn Lot Number. • 15 I 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 setup re *rents, Haman County Zoning Ordinance. 1 understand that It any hem is incorrect or false Info on bee p vide that this permit could be revoked. 405 ;,r • 3 -7 - ?.0 11 • ignature of Home er or Agent • Date 'EA'eedno July 1, 2004, a Counory pnoar{ment Movino Permit musters provided before a Set UP Permit will be issued. It /s purchased from the tax office of the county that the home is moved from. ',the home Is from a deafer, we need proof of year on the Form 500 and if available, the sent! number. List of inspection; and Egress requimmonts available upon request. Progress Energy customers must provide Premise Number. SETUP 4/09 Cami ny,6 33Z 7Y1 lYzO 03/15/2011 15:43 FAX 919 778 1981 ADCOCK APPRAISALS Inc (14 003 Ma r. 12. 1011 1 ; 1111.11m ?!sNUFACTLTRING INC. - Maynardvilla nu. yu�u r, 1 of 1 . 1 ...--. Sold To: 091620 • Invoice No..: 92 , : Remit To C91 IOND, � C M E _ P.O 510 - 1071 NBA. ELATION BOMBS•MOtRT AIRY Iaveiee Ds.-a• 1/07!2011 1044 17 ANDY GRIMM PAREWAY Modal Ye ..'.t 2011 OB E =SON AIRE. NO 27030 Appros.Sq > t 1.039. Bop: J P/0 tumba Retail Gust: ANDERSON Serial Ro...: Q11092281TM ' Approval Nor • Model t.225281 11 B7218 RIDGE m Ptncod By Ship To 1031620 'CLAYTON WOVj6S -M00NT AIMS •v rim •r ROD: 1E27748344 CASEZ,•a CHECK OA czeatnED PONDS 0014 HUD: pry Pelee Opt. "Description Qty Prim'" Opt. • Description t "D tion I CMlntOR • UFO laC.flE GM LIONS IN 42 6 AS 36 "7001ITAGE DOOR V /STORM BEDROOMS, OWN=G BOOM 1e pALLWAY* v/Dv.0BOLT AND n EwwOLE• 111111 PnIGHT & SMEAR= CHARGES 1 COTTA= DOOR VDEMEOLi to +Nd138IAL SURCHARGE AND 'PLIGHT =OVAAL% HITCH OBE. SUMECT TO CHARGE DUE TO THE WTI ALB.' CLAD WIIIDOWS V /ST0324S CHdacnbic MADRBS CONDTIIONS EAIarm ans MOTSR 023995 EAAU AnLE W/TLRBS (S) 1 . COACH LIGGETS HITCH END (1) 124000 HUD LABEL 3 - *SMALL BAY WWDOWBITCH END 023996 IDLER ABLE WITESS (S) VINYL SIDING 17/01"C 17/01"C C MITERS 160070 VAULTED CHLINCS TBRU -OVt 1 - 082000 MIKE POWER 22 -11 -30 1 325 160004 DASD WYWDOWE W/BTMS -VHT j4, 1 190 sPBCIAL zosnUCrIONS 132112 SUIGLES (OSATMER GRAY 1 1 SASHAY DUNE TER000SOUT 060003 TlteRMAL SONE III ' SILK S=RG W/ BURGUNDY MUTTERS CCM 19`PROSST YHBE RIVER WJICRIAKIS UPGRADD AVMs Carnal CLEVELAND YAUCEIS WISTRY 120 VSITE ACRYLIC =CEDES SINK •POTSCRWSE3R DISHWASHER *DROP.= SMOOTH T0P RANGE *2L71T -IN OVEN W/1r2CAOWAVE ' •escgs SASE IN MIMES 071200 • CAN LIGHTS• Ur A caul 1 • 092420 B �E AIP C 1 - . • tot UPGRADE CARPET PAD • VINYL ENTRE . • VIM Dr BALL BAIR VIAL IN MAR BATH . ORB -FLOOR DECKING ' 022022 STANDARD 710 SOCK RAMSLNUS CARPET 1 - 022112 9246 VOOD GRAIN VrCtl, 1 99 ••••9320 Vrevr. TN T23 DATES OA7.Y 30 GALLDR WATER HEATER • BACESPLASB IN BOTH BATES • 039995 OFT 2 RADOMA BATH !SUB SIAM= 495 60" DROP TR Tom 36" SHOUEE STAl2. 092420 B171TRAUM COMMA TOP . 031100 • SIRE PAUCsts (STD)' - 172161 • B.VIBSS TO THERMOSTAT - 161702 FURNACE ELEC 1Sri 7- 035237 36" GLASS SOMA DOOR 'AECmOGNDED AC SIBS 1.S 2 TOR" . ham l • « © `a Erin Rogers Homo Censwhant am ACT "Ch Caaa -RAIL BORDER 1 083434 PHONE SACS CO) 0US 338.789.6826 phone t• mown SIR t• Clayton Homes 336.7M.9512 tas PLAT WHITE ZBTERiOR DOORS THRO.OtR CESIING RAM W/LIGDT 1.R A MAR 1084 N. Andy GriMRh Mar,. r16261GWt,Nonhometeam MINI BLINas THEO -COY • • Mt, Al ry, NC 27030 wvnv,4ad6ynnhom &caM162 UpDAAOD LIGBztCG PEG •CDA ZNG - FAN VII.IGRT LR 6 MBA Age; MN holm .¢Y mewed tlras.. rlos, WAR uu18s Moth have Gam inspected Mativa to epparance and app11as1e sflny etadara•. ' 1WV61TCE IEEE DnSCLOSURws as REVBE.SE SIDS