MANUFACTURED HOME INSTALLATION PERMIT APPLICATION


Before filling out this form, please see the permit application instructions here to ensure the information on your application is complete.
You will be able to electronically submit required documents after completing this page.



To make a correction or modification to an existing permit application submitted or denied, check here.


Owner Information

Name  

Email Address

Phone Number

Street Address  

City   State

Zip Code

Installation Address

Address  

City   State

Zip Code

Unit Information

Unit Manufacturer  

Serial Number  

Year of Manufacture   Month Day Check here if date is not known

Rehabilitation permit required on Pre-HUD homes (any mobile home built prior to June 15, 1976)

If the mobile home came from a Mobile Home Park and is going into a Mobile Home Park, a Rehabilitation Permit is required prior to moving mobile home to the new location. A Rehabilitation Permit is also required if the mobile home came from out of State.

Where did this mobile home come from?

Address City

State Zip

Manufactured/Mobile Home Park Private Property

Size Dimensions (no decimals and round to nearest whole number) Feet by Feet    

Number of Stories

Dealer Information

Company Name  

License Number Classification

Phone Number

Email Address

Street Address

City State

Zip Code

Permit Purchaser

Name  

Phone Number  

Email   (Important - This email will be used to track and manage your application)  

Plan Review Information

Properly Licensed Entity(s) Performing Work

To add additional Installers and/or Contractors, click on "Add Additional Installer/Contractor" button below.

Installer/Contractor Company Name

License Number   License Classification

Phone Number

Email Address

Street Address

City State

Zip Code














Other Work (If you have checked 'Other'):