City of Rocky Mount Inspection Services MANUFACTURED HOME PERMIT APPLICATION
Instructions: Complete all pertinent fields, then read the information at the bottom of the form. Click the Submit button to send the information; click Clear to start over.
Applicant Name: Date:
County Project is located in: Nash Edgecombe		Codes to be applied, SBCCI or IBC
Project Address:		Model Home Name:
Property Owner:		Telephone:
Set-Up Contractor:		Telephone:
Address:		State License #:
City:	State:	Zip Code:
Project Supervisor:
Estimated Home Cost (minus subcontractor cost): $
Electrical Contractor Name:		License #:
Plumbing Contractor Name:		License #:
Mechanical Contractor Name:		License #:
Unit Type: Single Wide Multi-sectional		Total Sq. ft.:
Building Height:    Feet Number of Stories
Accessory Structures:
Sq. Ft. of Garage	Sq. Ft. of Patio	Sq. Ft. of Deck	Sq. Ft. of Porches
Sq. Ft. of Carports	Sq. Ft. of Basement	Sq. Ft. of Terraces	Fence
Comments:
Please fax a copy of a site plan showing distance from property lines, lot shape, size and relationship to streets to 252-972-1590.
I hereby certify that all the information in this application is correct and all work will comply with the State Building Code and all other applicable State and local laws, ordinances and regulations. The Inspection Department will be notified of any changes in the approved plans and specifications for the project permitted herein. I further understand that this is NOT an authorization to begin work. Work may only commence after approval and issuance of the permit. Owner/Applicant E-mail Address: Daytime Phone: