Suite 101 Waverly Akins Office Building
PO Box 550, Raleigh, NC 27602
Permits Staff (919) 856-6222 Fax (919) 856-6229
APPLICATION FOR MANUFACTURED HOME PERMIT
PERMIT # ENVIRONMENTAL SERVICES PERMIT # D Owners Name – Last: First: Phone # Street Address/City/State: Zip: Dealers Name: Phone: Project Street Address: Utility Provider:
City: State: Zip: Project Cost: Mobile Home Park or Subdivision: Lot # List existing structures on property:
Bedrooms: Baths: Other : Value: Serial # UL/HUD # Year: Make: Size: Color: Existing Deck New Deck Is Home being moved from within Wake County?
Set Up Contractor: License # Street Address: Phone # City: State: Zip: Fax # Contact Name: Phone: Electrical Contractor*: License # City: State: Zip: Phone # Plumbing Contractor: License # City: State: Zip: Phone # Directions to Project:
Applicant/Owner/Agent Name: Phone# Signature: Date: *Electrical work must be installed by contractor licensed in the State of North Carolina.
Exception: Any person may perform the work when both the mobile home and the land on which it is placed is are owned
by that person and the home is for their own use (not for rental purposes). Approval must be granted to the applicant for
wiring their home by scheduling an appointment with their electrical inspector before any work is performed.
Applicant agrees to comply with all Building Regulations and other applicable laws to the use of the structure and facilities
referred herein. The permit issued for work shall expire by limitations six months after the date of issuance if the work
authorized has not commenced. If after commencement, the work is discontinued for a period of twelve months, the permit
shall expire. No work, authorized by any expired permit, shall be performed until a new permit has been secured.
FOR OFFICE USE ONLY – DO NOT COMPLETE Jurisdiction: PIN/Tax Map/Parcel: Unique #:
Acres: Census: Zoning:
Water Supply: Public Private Waste Water: Public Private Lift Pump Required:
Flood Certification Required: Fee: