MANUFACTURED HOME: Building Permit Application

SITE AND PROJECT DATA

Check which is applicable:

New

Replacing

Description of Work:

Valuation of Proposed Project:

Parcel Number

No. of Bldgs. on Site:

Property Size:

Lot Number:

Plat/Development:

Flood Plain:

Yes

Sewage disposal:

Septic

Sewer

Sewer Contractor License #

Water purveyor:

Property Owner's Phone Number

Property Owner's Email Address

Is the Applicant someone other than the property owner?

Yes

Applicant Phone Number

Applicant Cell Phone Number

Applicant Email

Is there a seperate contact for this project?

Yes

Project Contact Phone Number

Project Contact Email

ALL INSPECTION RESULTS SHALL BE EMAILED TO:

Contractor:

Contractor Phone Number

Contractor Email

UBI or Contractor Lic #:

BUILDING DATA

Manufactured Home Square Footage:

Porch Square Footage:

Deck Square Footage:

Mobile Home Park:

Yes

Name of Park:

Manufactured Home Make:

Model:

Year:

Serial Number(s):

Number of Bedrooms:

Number of Bathrooms:

Type of Heat:

Other:

Lender/Issuer of Payment Bond:

Upload File(s)

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Lender/Issuer Phone Number

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Any changes will be reported to the jurisdiction in which the permit is valid immediately. By leaving the contractor information section blank, I hereby certify further that contractors (general or subcontractors) will not be hired to perform any work in association with this permit. I also certify that if I do choose to hire a contractor (general or subcontractor) I will only hire those contractors that are licensed by the State of Washington.

Signer:

Owner

Agent

Contractor