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OFFi US. Ep. <br />Received by:~ <br />Zoning Validati~' ~..K~j~ <br /> <br /> COMPLETE ALL SEC~ONS, 1 T~OUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 22o High $~c~j~ ~ ~ m ~ ~z ~ F~ OFFICE USE ONLY] <br /> <br /> MANUFACTUREDSTRUCTURE PLA'CEM~T <br /> <br /> ( ) Atm~d <br />C~mer~( ) New( ) R~t( ) ( ) Deta~ed <br /> <br />M~acm es ~ Y=ar of d~ Color ~ ~. t~gm: ,, Wide: <br /> <br />2. Location of Instalhtion <br /> <br /> ~/ll-~r~ ............. ~,;xo, , .... <br />Su~s~n ' J <br /> " ~t Bl~k Urban Growth Boundaw? <br /> .... ~vamWeH ( ) Spring ( ) <br /> <br />3. Contractor Information <br /> <br />( ) I und~rs~nd ~ag I must ~s~r as a ooast~ ~r ~ ~ s~ ~ sold or ~gd for sale b~og or u~ c~pl~. <br />( ) I w~ ~ my o~ g~e~ ~tra~, ' : <br /> <br />ff I ~;mge my m~d ~d do hi~ a g~ae~ ~tmc~t, I ~ ~tmct ~& a ~ac~r wbo ~ m~st~d wi~ ~e ~stmcfion Contractor's Boa~, and wiH <br />~c~a~ly no~y Ma~ Cowry nf the name of ~e contr~r. ~:~& <br /> <br />4. FeeSch~ule : ~ , ~ <br /> <br /> $182.~ = C. Additional ~sp~ti~ (~ $60.~ := __ <br /> ~) Sram Fee ~ ':20[~ = ~ff~ .': or R~spec~ <br /> <br />~, (1) ~g.'d Stmetu~ ~rag~ F~ ~ 40,00 ~r ho~r ~ boUT m~mm) <br /> <br /> (~) <br /> Mfg.'d S~cm~ S~ge R~ew~ <br /> <br /> (3) ~g Sumha~e (15,~ if a~hcab~) ~ 15.~ ~ <br /> RECBI~f: <br /> <br />I hereby certify that the above information is con. ct and that I have read and undagstand the Information Notice to Property Owners about Construction I~espon gib/lifies <br />on the reverse sld~ of Ibis form. <br /> <br />This. fee covers thc mantlfaclured ~tmctum placement, pluttlbing o:~nncctic~, clectficai connection and mechanical connection. Site evaluation, ~cptic permit, electrical <br />servme or plumbing waler/sewer lines am separate required pOtr~ilg. <br /> MC 15-64 Rev I1-91 <br /> <br /> <br />