Affidavit Regarding Medical Hardship Manufactured Home Permit – King County, WA

The Affidavit Regarding Medical Hardship Manufactured Home Permit is a one-page sworn statement from the King County Department of Local Services, Permitting Division, in which the applicant for a medical hardship manufactured home permit certifies the need for a temporary dwelling to provide daily care.

The applicant writes their name and the medical hardship manufactured home permit number, then certifies two things:

• The temporary dwelling is necessary to provide daily care, which Chapter 21A.06.262 of the King County Code (KCC) defines as medical procedures, monitoring and attention that are necessarily provided at the residence of the patient by the primary provider of daily care on a 24-hour basis.
• The primary provider of that daily care will reside on-site.

The applicant also acknowledges three conditions: the manufactured home is temporary and must be removed within 90 days of the permit expiring or when daily care is no longer required; the permit must be extended on an annual basis; and an updated physician's letter must be submitted each time the permit is extended.

The form states that a statement from the physician, certifying that a resident of the property requires daily care as defined in KCC 21A.06.262, is attached. The applicant signs and dates it, and a notary public in and for the State of Washington completes the "Subscribed and Sworn to" block with signature, seal or stamp and place of residence. The form is dated May 2019 at the foot of the page.

The applicant for a medical hardship manufactured home permit in King County completes and signs this affidavit. The form is written in the first person ("I ... am the applicant for a medical hardship manufactured home permit number ...") and refers to a specific permit number, so it belongs to someone who has applied for, or holds, that kind of permit.

The conditions behind the statements the applicant swears to:

• A resident of the property requires daily care as defined in KCC 21A.06.262, and a physician's statement certifying this is attached.
• The primary provider of that daily care will reside on-site.
• The applicant understands the manufactured home is temporary, that the permit must be extended annually and that an updated physician's letter accompanies each extension.

A notary public in and for the State of Washington must complete the notary block, so the applicant has to appear before a notary. The form does not say that anyone other than the applicant may sign it. This affidavit concerns a permit from the Permitting Division; it is not a property tax form, and it is not used for other kinds of permits.

The affidavit is tied to the medical hardship manufactured home permit: it names the permit number and says a physician's statement is attached, so it is prepared for that permit. No separate due date is printed on the form.

The acknowledgments on the form set the timing that follows the permit. The permit must be extended on an annual basis, and an updated physician's letter must be submitted each time it is extended. The manufactured home must be removed within 90 days of the permit expiring, or when daily care is no longer required. For questions about when to submit the affidavit with an application or an extension, call the Permitting Division at 206-296-6600.

The form names no mailing address, portal or appointment rule of its own, so the way to deliver it is set by the King County Permitting Division. Details the form does give:

• Contact: Department of Local Services, Permitting Division, 206-296-6600, www.kingcounty.gov.
• Package: the completed affidavit with the applicant's signature and date, the notary block completed by a notary public in and for the State of Washington, and the attached statement from the physician certifying that a resident of the property requires daily care as defined in KCC 21A.06.262.
• Permit extensions: the form says an updated physician's letter must be submitted each time the permit is extended.

Ask the Permitting Division how and where to deliver the package for your permit, and whether any fee applies. FillingPDF lets you fill out and download the PDF; submission follows the county's channels.