Manufactured Home Application Manufactured Home Application Please Select One:(Required) Single Wide Double Wide Triple Wide Site Address:(Required)Parcel Number (Optional):Owner of Manufactured Home:(Required)Contractor Name:(Required)Contractor License Number:(Required)Certified Installer Name:(Required)Certified Installer Number:(Required)Year:(Required)Manufacturer:(Required)Model:(Required)Dimensions:(Required)Serial Number:(Required)Valuation:(Required)Number of Bedrooms:(Required)Number of Bathrooms:(Required)Installation ChecklistFooting Type:(Required) Concrete Block Continuous Runner Other If "Other" Selected Please List:Skirting Type:(Required) Concrete Concrete Block Metal Treated Wood Other If "Other" Selected Please List:Tie Down Type:(Required) Auger Dead Man Poured Other If "Other" Selected Please List:Zoning ChecklistPit Set:(Required) Yes No Siding Material:(Required) Metal Wood Other If "Other" Selected Please List:Roofing Material:(Required) Metal Asphalt Other If "Other" Selected Please List:Signature:(Required)NOTICE TO APPLICANT Every Manufactured Home Permit must contain the name(s) and certification number(s) of the certified installer(s). The Union Gap Building Department must refuse to issue a permit until the application is complete. On site, a certified installer must be present at all times during installation. If a certified installer is not present your job may be shut down. * SEPARATE PERMITS ARE REQUIRED FOR ACCESSORY BUILDINGS. ** IT IS THE APPLICANT’S AND/OR CONTRACTORS’S RESPONSIBILTY TO CALL FOR INSPECTIONS. FOR SCHEDULING OF INSPECTIONS, PLEASE CALL (509)575-3638. ** THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY under penalty of perjury that I have read and examined this application and all attachments 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. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. I ACKNOWLEDGE and consent to a right of entry to the property subject to the application by the Union Gap Building Department during regular City business hours to perform required inspectionsDate:(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PhoneThis field is for validation purposes and should be left unchanged.
