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City of Summersville Building Permits
400 North Broad Street – P. O. Box 525
Summersville, WV 26651
(304) 872-1211                                                             

 

Application for Manufactured (Mobile) Homes in Mobile Home Park

 

  • Complete this form when moving a manufactured/mobile home into an established mobile home park.

 

Name of approved Mobile Home Park:_______________________________________________

 

Lot Number:_____________

 

Mobile Home Owner Information:

 

First Name:_____________________________Last Name:______________________________

 

Phone Number:_________________________

 

Current Mailing Address:_________________________________________________________

 

                                    City:__________________________State:______Zip Code:__________

 

Mobile Home Information:

 

Mobile Home Size:___________ft.  x          ft.                            Year of Manufacture:__________

 

Mobile Home Make:__________________________________Serial Number:_______________

 

Deck Size (If larger than 4’X4’)                    ft.   x       ft.______Estimated Value:_____________

 

Installer’s Name:_____________________________________A/C Unit:___________________

West Virginia Mobile Home Installation License Number:_______________________________

 

 

 

Applicant:______________________________________________Date:___________________

 

AFFIDAVIT

 

I hereby authorize:____________________________________to act as my Agent in regard to my property in the City of Summersville in known as _________________________________

necessary permits required to place a mobile home on said property.

 

Owner’s Signature:____________________________________________Date:_____________

 

 

 

Application for Manufactured (Mobile) Homes

Private Lot

 

 

       NoAre there any other mobile homes on parcel?    Yes  

 

  (     No  Is property in the floodplain?     Yes  If yes community panel number & effect date & designated zone

                                                                                                                must be submitted )

 

     City Sewer?   Yes     No  City Water?  Yes      No  

 

 

Mobile Home Owner Information:

 

First Name:______________________________Last Name:_____________________________

 

Phone Number:___________________________Cell Number:___________________________

 

Current Mailing Address:_________________________________________________________

 

Property Owner Information: (if different from mobile home owner)

 

First Name:_____________________________Last Name:______________________________

 

Phone Number:_________________________Cell Number:_____________________________

 

Current Mailing Address:_________________________________________________________

 

Mobile Home Information:

 

Size of Mobile Home:____________ X ______________ Year of Mobile Home:_____________

 

Make of Mobile Home:_________________Serial Number of Mobile Home:________________

 

Estimated Value:$_______________________Deck Size (if larger than 4’ X 4’)______________

 

Installer’s Name:________________________A/C Unit:________________________________

 

West Virginia Mobile Home Installation License Number:_______________________________

 

I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE INFORMATION ON THIS APPLICATION IS TRUE AND CORRECT.

 

Applicant’s Signature:_________________________________________Date:_____________

 
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