Fillable LIEN AGENT REQUIRED? NO YES (Jackson County)

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LIEN AGENT REQUIRED? NO YES (Jackson County)

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JACKSON COUNTY PERMITTING & CODE ENFORCEMENT
Manufactured Home Placement Application
Sylva Office: 401 Grindstaff Cove Rd, Suite 145, Phone: 828-586-7560 / Fax: 828-586-7563
Cashiers Office: 357 Frank Allen Road, Phone: 828-745-6850 / Fax: 828-745-6867
LIEN AGENT REQUIRED? NO YES
LIEN ENTRY NUMBER: _________________________
PROPERTY PIN: ______________________________ IN AN EXISTING M/H PARK?* NO YES
Permits will not be issued without Property PIN and proof of an approved method of sewage disposal.
NAME: ____________________________________________ PHONE: _____________________________
ADDRESS: _______________________________________________________________________________
CITY: _________________________________________ STATE: ___________ ZIP: _________________
E-MAIL ADDRESS: ________________________________________________________________________
HOME TYPE: Singlewide Doublewide Triplewide Camper/RV Number of Bedrooms: _____
LAND USE: Residential Commercial (Must have NC Licensed Subcontractors)
CONTRACTORS
NC LIC #
PHONE
MH SETUP:
ELECTRIC:
PLUMBING:
MECHANICAL:
*If you are installing more than one manufactured home you must discuss your plans with us prior to submittal of
this application. You may be required to submit a site plan and fill out an Application for Construction of a
Manufactured Home Park.
DETAILED DIRECTIONS TO SITE (IF POSSIBLE, PLEASE INCLUDE A 911 ADDRESS)
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
POWER PROVIDER: _________________________ JOB # (if Duke Energy): ________________________
I hereby certify that all information in this application is correct and all work will comply with the State Building
Code and all other applicable State and local laws and ordinances and regulations. The inspection Department will
be notified of any changes in the approved plans and specifications for the project permitted herein.
SIGNATURE: _________________________________________ DATE: ___________________________
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(Parcel Identification Number)
JACKSON COUNTY 9-1-1 OFFICE JACKSON COUNTY, NORTH CAROLINA
401 Grindstaff Cove Rd., (Mail) ADDRESS REQUEST FORM
Sylva, NC 28779
(828)586-7537
(828)586-7573 fax Date of Application:
The following information is required in order to assign you a permanent house number and road name.
This address is necessary for Jackson County to provide you, the homeowner, with adequate emergency
service when a 9-1-1 call is made. Your address will be assigned as soon as possible after your request is
made. (The driveway must be cut in on the property before the address can be generated.) This address
must be posted on your home or at your driveway before a certificate of occupancy can be issued. This
form must be filled out if you are building a new home or placing a mobile home on your property. Leave
this form at the building permit office. The assigned address must be posted on your home or at your
driveway before a certificate of occupancy can be issued.
Homeowner’s Name: Telephone: ______________________
Contractor’s Name: Telephone: ______________________
Road Name: PIN # __________________________
Building Permit #: Lot # (if applicable): ________________
Directions to building site:
Name of nearest neighbor: ____________________________________________________________
Description of new home: (example: 2-story gray house)
If this home is not to be your permanent full-time residence, please list an out of town mailing
address and telephone number where you can be reached.
Mailing Address:
Telephone:
FOR OFFICE USE ONLY
NEW HOME ADDRESS:
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LIEN AGENT REQUIRED NO YES (Jackson County)

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Completed 14 December 2020

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