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MARION COUNTY BUILDING INSPECTION <br /> ,$0i~ OFFiC~.~USE~O.~LYI 220 High Street L'>IF,_ ., FOR OFFICE USE ONLY <br />IZoningValidation~ I 8:~-4:3~m~one5~7~ ~ ~ ~ ~,~/ IRear: /~ I <br /> MANUFACTURED STRUCTURE PLA~,~t 199~' ' '-- <br />CO~LETE ALL SEC~ONS, 1 T~OUG~ 4 PER~T APPLICATION <br />1. lob Description ~0~ COUNTY <br /> <br />2. Location of Installation <br /> <br /> So.ion Towns~p Range Z~e Map '~amr Su~ls'; <br />.... LotWjd~ '~e~l LotDe~h"'"q~l Acme ~g.~t.~ Co~/ef ~ PhvateWe[[ ( ) Spring ( ) <br /> ........... Commm~tyWe~( ) City ~ <br /> <br />3. Contractor Information <br /> <br />(X) I own, ~slde M. or ~ m~ide in 6c eomplet¢~ stm~u~, <br /> <br />If I hi~ subcontractom, I wJ~[ bJ~e only sub¢ontmetom reglsterrd with the Construction Contractors Board, <br /> <br />If I ohzmge my mind and do hit~ a general Contractor, I will con*tact with a ¢catractor who is ~glstered with the Conatmetlo~l Contractors Board, and WI~ <br />irmnedlatel¥ notify Marion Cormt¥ of the name of the contractor. <br />C°atract°r Bu~ine~ Name & ¢" 8]~ ~¥/'~tI'''t ~"' a~ I Mailing Address: j .~'/~ <br />-- . 3% <br />( ~[ ) I am [,,[¢gist~red builder OR the luthod~d t~presentative of a ragiSte~d build.r, <br /> <br />4, Fee Schedule <br /> <br />A, (1) Manufactured Home <br /> <br /> or Modular Unit Placemem/Cc~m¢ction <br /> <br /> (3) Stme Sumha~ <br /> <br />g. (1) Meg,'d St~lcm~ Storage Fee <br /> (2) ~g.'d Structure Smmse R~newM <br /> <br /> 0) ~nthg Sureha~e (15,~ if ap~icable) <br /> <br />$I$2,00r..~_ C, Addilionallnapecdon (~ $60,~:= <br /> 20,00 = <br /> <br /> 'IOTAL: $~ <br /> ~ 40,~ ~r hour ¢ boer mi~mm) <br /> ~.00 =.~ <br /> <br /> RECEI~: <br /> <br />"' ,,, Date:i2-' ~"Z-- ~!NameO'ApplI¢ (p ease pr nt) <br /> <br /> MC 15-64 Rev 11-91 <br /> <br /> <br />