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MARION COUNTY BUILDIN~,,al[NSPF~T. jON <br /> <br />I Zomng Validation~ ] 8.~. mM.3~m. ~o~ 58S-514T ~nt: <br /> <br /> MANUFACTURED STRUCTURE <br /> PERMIT APPLICATIOM ..... <br /> <br /> 1. Job De~ripfion <br /> <br />Residenthd(X ) New(X) Replacem~t( ) Oaxage or Caxpor~ <br /> ( ) Attached <br />Comrn~roal( ) New( ) Rcphccmmt( ) ( ) Detached <br /> <br /> 2. Location of Installation <br />i Property Owne~r <br />: lobAddr~ss <br /> <br />Mailing Addres~ <br /> <br />Cross ~trcct <br /> <br />' Subdix4sioa <br /> <br />Section ] Township Range <br /> <br />Lot <br /> <br /> 3, Contractor Information <br /> <br />, (X) I own, reside in, gr will reside in the completed structure. ~' <br /> <br />i ( ) I will be my own general contractor. <br /> <br />immediaml7 notify Marion County of the name of thc contractor. <br /> <br />Aoth0~d agent or hia~'ec: /% ,~ , / '" Mailing Address' <br /> ,,,'J ' :/ I <br /> <br />14: Fee Schedule <br />A. (1) Manufactured Home <br /> <br /> or Modular Uni[ Plac~incmgConnect~on <br /> <br /> (2) State Fee <br /> <br /> O) State Sumha~c <br /> <br />B, (l/ ~g.'d Structure $~gO Fee <br /> (2) Mfg.'d S~ctu~ S~mge Renewal <br /> <br /> O) ~ng Sumha~e (1~.~ ff a~ab~) <br /> <br /> @ $182.00~ /~)~ d'~ C. Additionallnspr~tica @ $60.~=_~ <br /> <br /> ~TAL: $~ E, ~ ~s~fi~s not listed @ $40 ~ = ~ <br /> ~ 40.00 ~r hour (2 h~r miami) <br /> <br />~ 1~,~=~ <br /> RECEII~: <br /> <br />Sign~tumofAppllcant: '/1~[~,,C7~ Date: ~ '1 )~ <br /> fee c~ers ~e man~actumd stmc~pla~m~h/I plumbMg ~nnccfio~, ~tfi~ c~c~on ~d mechanical co~ecfion. 'Site cvaluafio~,l s :p c e~ , c ectfica <br /> MC 15-64 Rev 11-91 <br /> <br /> <br />