MOBILE/MANUFACTURED HOME INFORMATION SHEET
FLORIDA ADMINISTRATIVE CODE RULE 15C-1 and 15C-2
DATE: PERMIT #:
OWNER INFORMATION
Owner Name: Phone:
Construction Address: Parcel #:
Lot(s): Block: Section: Subdivision:
CONTRACTOR INFORMATION
Licensed Dealer/Installer: Phone:
Address:
License #: Installation Decal #:
Manufactures Name:
Roof Zone: Wind Zone:
Number of Sections: Width: Length: Year: Serial #:
Installation Standard Used (check one):
☐ Manufactures Manual ☐ 15C-1
SITE PREPERATION
Debris and Organic Material Removal Compact Fill pg#
Water Drainage: Natural Swale Pad Other pg#
FOUNDATION
Load bearing Soil Capacity or Assumed 1000 PSF pg#
Footing Type: Poured in Place Portable Size/Thickness pg#
1-Beam or Main Rail Piers: Single Tiered Double Interlocked pg#
Size of Piers: Placement O/C pg#
Perimeter Pier Blocking: Size Placement O/C pg#
Ridge Beam Support Blocking: Size Number Location(s) pg#
Ridge Beam Support Footer: Size Number Location(s) pg#
Center Line Blocking: Size Number Location(s) pg#
Special Pier Blocking Required? (Fireplace, Bay Windows, Etc.) Yes
☐ No ☐ pg#
Mating of Multiple Units: Mating Gasket Type Used pg#
Fasteners: ROOF Type/Size Spacing O/C pg#
ENDWALLS Type/Size Spacing O/C pg#
FLOORS Type/Size Spacing O/C pg#
ANCHORS
Type: 3150 Working Load 4000 Working Load pg#
Head of Unit: (Top of Foundation to Bottom of Frame) pg#
Number of Frame Ties Spacing O/C Angle of Strap Degrees pg#
Number of Roof Ties (If Required) pg#
Number of Sidewall Anchors Zone II Zone III pg#
Number of Centerline Anchors Number of Stabilizer Devices pg#
Vents required for under floor space (1 SF/150 SF of Floor Area) Number pg#
COST OF JOB: Building
Electric
$
$
Mechanical
Other
$
$
Plumbing $ Total Cost $
SUBCONTRACTOR INFORMATION
Electrical:
Mechanical:
Plumbing:
REVISED 3/8/16
State License # Comp #
State License # Comp #
State License # Comp #
