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FOR OFFIC~E USE <br />Received by:/~Z~-,..~, q <br />Zoning Validatip~/'ff~-'-' <br /> <br /> MARION COUNTY BUILDING' INSPECTION <br /> 220 High Sm:~E~' ~,~ ~ OFFICE USE ONLY] <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br />CO~TEALL 8EC720N$, } ?~ROUO~ 4 PER~T APPLICATI~N ~0DNTY <br /> Job Da~ccipfion BUI~iNG INSPECTION <br /> <br />Location of Insmlhfion <br /> <br />~Subdivis~ I ~ l ........................... La I Bl~k Urban O~wlh Bounda~? <br /> <br /> Se~i~l TOW~SMp Range Z~e ~ Map Watgr St~ly: <br /> PfivamW2ll ( ) Sp~ng ( ) <br /> <br />3. Contractor Information <br /> <br />I reside ~, or w~l reside ~ the c~pl~d stratum. - ' <br /> <br /> bite subcontractors, i will hire only subcontractors registered with the Construction Contractors Board, <br /> <br /> chmg~ my mMd and do him a general ~n~acto[ I ~ ~n~ct M~ a emmetor w~ ~ ~gism~d wi~ ~e Cons~cfion Contractor s Board, and wffi <br />~cd[amly no~y Marion Comty of thc n~ of ~c contracton <br /> <br />Authorized agent or leasee: tr '1 ~ ~ ]Mailing <br /> <br />[ Vhm~;-76c~. 77,4q <br /> <br />4. Fee Schedule <br /> <br />,.3 <br /> <br />A, (I) Manufactured Home <br /> <br /> or Modular Unit Plaeemem./Connecfion <br /> (2) State Fee <br /> <br /> l'{aablc)I-- <br /> <br />@ 20.00 =~ <br />@ 9.1o = <br /> <br /> TOTAL: <br /> <br />(1) Mfg,'d Structure Storage Fee <br />(2) Mfg.'d $tfuctu~ Slorag~ R~n~wal @ 25,00 =__ <br />(3) 7~ning Surcharge (15100 if appl.[eable) @ 15.00 -~ __ <br /> <br />Cl Additional Inspection @ $60,00 =__ <br /> or RMnspeetion <br /> <br />D. Inwstigation Fee <br /> <br />@ 40.00 per hour (2 hour mjrdmum) <br /> <br />@ $40.00 ~ ............ <br /> <br />Name of AvpUcam (please l:n. htO: "~l ~ ~l ~ J Phone: ~/~ 4 '77 q~/ <br /> <br />service or plumbing water/sewer lines are separate required permits, MC 15-64 Rev l ] -91 <br /> <br /> <br />