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MANUFACTURED HOME INSTALLATION PERMIT APPLICATION CITY OF MIDLAND – BUILDING DEPARTMENT 333 W. ELLSWORTH ST., MIDLAND, MI 48640 [PHONE REDACTED] email: [EMAIL REDACTED] MANUFACTURED HOME ADDRESS__ OWNER _ PHONE MOBILE HOME PARK MANUFACTURER/MODEL/YEAR _ LICENSED INSTALLER INFO: (HUD Licensee required for new mobile homes; State of MI Licensed Manufactured Home Installer required otherwise) LICENSEE NAME__ LICENSE NUMBER ADDRESS CITY/STATE/ZIP _ PHONE EMAIL HUD QUALIFIED INSPECTOR INFO: LICENSED ENGINEER ARCHITECT_ PIPIA_ DAPIA_ ICC INSPECTOR _ (Please check one) INSPECTOR NAME_ LICENSE NUMBER ADDRESS CITY/STATE/ZIP PHONE EMAIL 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 THAT I HAVE READ THIS APPLICATION AND 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 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SECTION 23a OF THE CONSTRUCTION CODE ACT OF 1972, 1972 PA 230, MCL 125.1523A, PROHIBITS A PERSON FROM CONSPIRING TO CIRCUMVENT THE LICENSING REQUIREMENTS OF THIS STATE RELATING TO PERSONS WHO ARE TO PERFORM WORK ON A RESIDENTIAL BUILDING OR RESIDENTIAL STRUCTURE. VIOLATORS OF SECTION 23a ARE SUBJECTED TO CIVIL FINES. SIGNATURE CONTRACTOR PRINTED NAME_ DATE MOBILE HOME INSTALLATION PERMIT FEE: $25.00