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Yes
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Yes
No
Yes
No
"Area A" Yes
"Area B" Yes
No
Yes
No
Yes
No
Mobile Home Conversion
Mobile Home Placement
Pre-Manufactured Placement
TUP Placement
Manufactured Home Placement and Conversion Combination
Manufactured Home Conversion
Manufactured Home Placement
Yes
No
Yes
No
Yes
No
Type Full Name :
Sign With Hand
Clear
Done
State
Address
City
List Existing Buildings
Certification
Permit Fee
I hereby certify that all information supplied in this application is correct, and complete to the best of my knowledge, and I agree to save, indemnify and keep harmless the County of Churchill and its officers, employees and agents against all liabilities, judgements, costs and expenses which accrue against the County in consequence of the granting of this authorization.
Property Details
Same as Owner?
Applicant Details
Phone #
State
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Do you have the Owner's Permission?
(Length x Width, ft/in)
Email
Owner Details
Contractor Details
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Make
License #
Name
The fee due for this application:
Do you have Legal Access?
Zip
City
I have received and read the handout titled "Dust Control in Churchill County"
Name
State
Phone #
Manufactured Home Permits
{[CNAME]}
155 N. Taylor Street Suite 170
{[CITY]}, {[STATE]} {[ZIP]}
775-428-0264
churchillcountynv.gov/building
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Name
Model
Serial #
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Email
Address
Zip
Required Documents
What is the Work Type?
Attach the Required Documents below:
MISSING INFORMATION WILL DELAY PERMIT PROCESSING TIME
Plot Plan
Foundation Plan (If Applicable).
Written Permission from Owner (If Applicable).
If the parcel that the manufactured home is being placed on is in a flood zone, Elevation Certificate is needed from a surveyor or engineer verifying what elevation the lot is at.
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License Fee:
Reference Number:
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