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MARION COUNTY BUILDING <br />['FOR. OFFiC. E USE OJq~.YJ 220 High Street NE fl~O~l[~ FOR OFFICE USE ONLY1 <br /> <br /> MANUFACTURED STRUCTURd~~[~ <br /> COYOTE ALL SEC~I~ONS, 1TBROUGII 4 PER~T APPLIC~[~ <br /> 1. Job Dc~fipfion ~ ~ ~ ~ <br /> <br />2. Location otlnstallation <br /> <br />Stthdi~si~ ' ~t {'Bilk Urban G~wlh 8ounda~7 <br /> <br />Se~ioa Towns~p ~ange ~e Map Water So~ly: <br /> Pfiva~eWe]l ( ) SprJs~g ( ) <br /> <br />3, Contractor Information <br />' o 'kyow.e, ta <br /> <br />( ) I will ~ my own g~¢~ ~t=~, <br /> <br />immcdlat~ly notify Marion County of the nam~ of the contractor, <br /> <br />[ Phone:7 t.{-q 'tq¢( <br /> <br />4. Fee Schedule <br /> <br />A. (1) Manofactured Home <br /> <br /> (2~ Sta~e Fee <br /> <br /> (~) SLat~ Surcharge <br /> <br /> (4) ~ning Sumha~e (15.~ if ap¢icable) <br /> <br />B. (l) Mfg.'d Structure Storage <br /> @ <br />(2) Mfg,'d Stmcmm Storage Renewal @ 25.00 <br />O) Zoning Surcha~* (15,00 ifapplicabl*) <br /> <br />C, Addkionallaspeetlon ¢O__ $60.00 <br /> <br />D. Investigation Fcc <br /> <br />E. Other Bs~cctlon~ not lislcd <br /> @ 40.00 per hour (2 hour minimum) <br /> <br />@ $40,00 =.__ <br />RECEIFI': <br /> <br />I hereby cerd fy that Ibc above Jn~ormalion is correct and tha: I have mad and understand the Jnfom~atiOn Notlc~ to Ptopelly Owners abotlt Coostractlon RespOnsihJlideg <br />Oa the reverst~ side,of this form, /~ · '~ <br /> <br /> MC 15-64 Rev ]1-91 <br /> <br /> <br />