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MARION COUNTY BUILDING INSPECTION <br />· ro~l OFFIC)fl ~S~E 9NLY 220 High Street NE [FOR OFFICE USE ONLYI <br /> R¢ce. ived b.y:~ I S~m, OR 9730! ,[~ City 8~ Requlr~enta: <br /> <br /> ~588-794S ~ ]L~tSlae: /~ mghtSjde: <br /> MANUFACTURED STRUCTU~ C~T <br /> PER~ APPLICATION <br /> CO~LgTg ALL $gCI1ON8.1 T~OUGI-I 4 <br /> <br />2. Location of Inshalhfion <br /> <br />Sub~v~ion * La ........ ] Bl~k ~rban Gmmh Bounda~? <br /> ................ Pfiva~ W~ ( ) Sp~g <br /> ~ m~h ~ ~ I~g. ~t ~S Comer ......... Commu~ly W~ ( ) City <br />~ wla~ tt2~ ..... :l a~ .......... <br /> <br /> 3. Contractor Information <br /> Mailing Address Phone No. ~ <br /> ) I ow~ msi~ in~ or will reside in thc completed stm~tt~. <br /> <br />! ( ) I will be my owa geaerul ¢ontraaor. <br /> <br />I/mmedlat~ly notify Marion Cotmty of the name of the contractor, <br /> <br />[4. Fee Schedule <br />A. (1) Manufa~ur~dHome <br /> <br /> or Modular Unit Placemcnt/Cotmec~ion <br /> <br /> (2) State Fee <br /> <br /> ¢3) State Surcha~e <br /> (4~ ~,,,',,g 3urcharge t l ~,O~ lI appltcable) <br /> <br />B, (1) Mf~,'d Stmet'ure Storage Fee (2) Mf§.'d Stmcmm Storage Ren~wul <br /> <br /> (~) Zoning SureDarge <br /> <br />I 7~,q-?zeq,, <br /> <br />@ $60,00 .-~__ <br /> <br /> @ 40.00 Per hour (2 hour minimmn) <br />@ $25,00=__ <br />' · <br />@ 2200 =__ "" TOTAL = $, <br /> <br /> RECEIPT: <br /> <br />S,g~amreofAppHcant: [ ~ ~ Date: ~ )~, t~4 <br />MC 15-64 Re~ 11-91 <br /> <br /> <br />