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FOR STAFF USE ONLY PERMIT# Building Division 525 N 3rd Ave, Pasco, WA 99301 P: [PHONE REDACTED] www.pasco-wa.gov I [EMAIL REDACTED] Manufactured Home Installation Permit Application Site Address: Parcel Number: Set up Costs: $ Home Cost:$ TOTAL Cost of Project: $ Applicant is (check one): Owner Installer Other: Legal Property Owner: Phone No.: Address: Email: Installer: Phone No.: Address: Email: WAINS Pasco Business License MFH Manufacturer Model Name Model Year Serial Number # of Bedrooms # of Bathrooms Square Footage Length x Width HOMES BUILT BEFORE JUNE 15, 1976 Required for submittal of this application: Completed application Site Plan Authorization from Park Copy of Title proving ownership Life/Safety Certification - Labor & Industries HOMES BUILT AFTER JUNE 15, 1976 Required for submittal of this application: Completed application Site Plan Authorization from Park Copy of Title proving ownership I certify the information furnished by me is true and correct and that I am the owner of the subject property or I have been given express permission by the owner of the subject property, to submit this application for permit. I will comply with all provisions of law, code and ordinances governing this type of construction work, including state contractor registration laws. I understand that, once accepted, this permit application is valid for 30 days. If the permit is not obtained within 30 days, the permit application and all submitted building and site plans will be destroyed. Applicant Name (Please Print) Applicant Name Signature SIGN