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MARION COUNTY BUILDING INSPECTION <br />FO.R. OFFIC, ljl USE ONLY: " 2!20 High Street NE /FOR OFFICE] USE ONLY[ <br /> <br />Date: ~d~e - ~ 5sa.~9~ .] ~,: /~ }~ $ia~:/~ { <br /> MANUFACTURED STRUC~E PL$~M~Ta~ ~ - <br /> PER~TAP~ICATION~.4 /V I~,~ <br /> COYOTE ALL SEG~ON$, 1 T~OUGH 4 <br /> <br />Location of. Installation " . ~ ~'~ ~%j~ <br /> <br />Subdivision : 'Lot ] Block " Urban O~wlh Boundary? <br />.... ~o~,~,~%//~e~L ~ s~¢~./~ · ' ' ~ ~ ~ ~ <br /> PHvat~W~g ( ) Spmg ( ) <br /> <br />3. ContraCtOr Information :" <br /> <br />:{ ),I ~d~n~d ~at I must m~mr a~ a ~t~ ~c~r ~ ~:st~ is.~old or offing for sal~ b~fo~ or u~ ~pk6on, . <br /> <br />~ I h~e sob~nt~emrs. I w~ ~ ~y subo~tmet~ mg~ ~ ~e ~s~a~ C~ac~ B~, <br /> <br />:4. Fee Sehedule :: <br />A, (1) Manu£actumdHom¢ <br /> <br /> or Moaular Unit Place. m~nt/Cc~mr, ction <br /> <br />B. (1) Mfg.'~ $tmcmm SWmge Fee <br /> <br /> @ 40.00 per hour (2 hour minimurn) <br />@ $25.0o=__ <br />@ 25.00'--" : ': · <br /> 15.00 k: : ' <br /> <br />@ $40.oo <br /> <br />TOTAL= <br /> <br />i he,by ceaify that [he above in~oixnation is con,ct and that I ha~ md ~ ~cnmnd ~c ~f~ati~ Nofica t0 ~e~y <br />N~meofAppllcant~~~ ~~ ~, Phone: 7~ <br /> <br /> <br />