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MARION COUNTY BUILDING INSPECTION <br /> <br />f. FO' ,OFyJ ONLY1 <br />R~ived by~ ~ ~ <br />Zoning Validatiow I /~ <br />Date: ~ ~.__~ <br /> MANUFACTURED STRUCTU~aCEMEN~ <br />CO~LETE ALL SEC~ONS, <br />1. Job D~ri, <br /> <br />Rcsid~ntlal( ~ New( ~ l~plaCemenff ) "?';~'i~? Garage or Carport <br /> ( ) Attached <br />Commercial( ) New( ) Replaeem~'~t( ) ( ~Deiached <br /> <br />2. Location of Installation <br /> <br />~/~ OL 9 2 $ Yz sit, No. <br />Mo<~ .omc P.~ M/4 ........................ 8~ce ~ Y~ ) <br />S~tlm / Tomship/~,~ Raag~ ~ ~e ~ ~ Map' Wamr Su~[y; ..................... <br /> ' Private <br />L~Wid& /~/ L~m~ ~ Aem~ ~g,~t Comer <br /> <br />3. Contractor Information <br /> <br />( ) l ~dcmsmnd ~at I must ~s~r as a c~s~mcfi~ ~c~ ff ~a s~a~ is s~d or off, md for s~e before or u~n c~pl~on, <br /> <br />If I hire subcontractors, i will hi~ only subcontraetor~ registered with the Constm,tion Cmtractors Board, <br /> <br />If i change my mind and do hire a general contractor. I will contract wi~h a cea~ctor who is registered with the Construction Contraetofs Bo* ~I. and will <br />imm~dlately no'fy Marion County of th~ mime of the eontraotor, <br /> <br />Contractor Business Nam* & #: IMailing Address: { Phone: <br />( ) I am a r~ist~red builder OR the authorized representative of a r*gist~red bulld~r. <br />Authorized agent or inasem ............. {~V~aillng'Addt~ss: I Phone: <br /> <br />! 4¢ Fee Schedule ' <br /> A. (1) Manufactured Hom~ <br /> <br /> or Modular Unit ?la¢~a~I/Connaclion <br /> (2) State Fee <br /> <br /> 0) Stat~ Surcharge <br /> <br /> (4) Zoning Sumha~ (15,¢0ffappllcable) <br /> <br />B, (1) Mfg,'d Stvactor~ Storage <br /> (2) Mfg.'d Stmctore Storage RJ'_newal <br /> <br /> ~) Zoning Surcharge (15,0O ff applicable) <br /> <br />C. Additional Inspection <br /> or Re, inspection <br /> <br />D. Invesffgatlon Eec , <br /> <br />@ $60.0O= <br /> <br />I hereby certify that the above informaoon is correct ~nd that I have read and undersland the Information Notice to Property Owners about Construction Responsibilities <br /> <br /> <br />