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2. Application Date*
   Application Date
4. Applicant Information
6. Name*
7. Email Address
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Fax Number
18. Does applicant own the land?*

    1. Yes
    2. No
19. Please state the landowner's name*
23. Development Information
25. Type of Structure*

    Choose one answer

    1. Conventional Dwelling
    2. Modular
    3. Double/Triple Wide Manufactured Home
    4. Single Wide Manufactured Home
    5. Other
26. Describe the property development*
28. Is this a new or used manufactured home?*

    1. New
    2. Used
29. Please state the previous owner's name*
31. Year
32. Make
33. Color
35. Size
36. Cost
38. Is the manufactured home located in a mobile home park or subdivision?*

    1. Yes
    2. No
39. Please state which MHP/Subdivision*
41. Is the manufactured home being moved from a mobile home park or subdivision?*

    1. Yes
    2. No
42. Please state which MHP/Subdivision*
44. Was a moving permit acquired to relocated the manufactured home?*

    1. Yes
    2. No
45. Applicant must contact the Planning/Zoning and Code Enforcement Office to obtain a moving permit. No E-911 Address will be assigned until a moving permit is submitted to this office.
    Permit Application
49. I hereby certify that I have read and understand this document and know the same to be true and correct.
51. Name*
52. Date*
    Date
54. Please include any surveys or maps of the property that may include the location of structures and/or driveways!!!*
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62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field