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MARION COUNTY BUILDING INSPECTION <br /> <br />' FORfOFFIC~USE 0NLYI <br /> Zoning Valk. Lat,on'~..zz.~--2/n]~ I <br /> Date: 0... ~/~ 'qff ' [ <br /> <br /> 220 High Street NB~ ~ ~F~i~t OFFICE USE ONLYI <br /> <br /> ( '_, t <br />MANUFACT~EDSTRUCTURE P~E~ <br />PER~TAPPLICATION <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 <br />1. Job Descri >tion MARION ~OUNTY <br /> <br />2. Location of Installation <br /> <br /> 3, Contractor Infom~ation <br /> <br /> ( ) I under.nd ~akI must ~s~r as a const~c~ ~c~ ff ~e s~ i~ sold or ~emd for sale b~om or u~n c~p~on. <br />,( )I~myo~gm~c~tm~ I ' · <br /> <br /> If I ch~ge my ~d and 4o ~ a ge~ ~n~c~r, <br /> <br /> C~ ~r Business Name & <br /> ~ ' :Z,~/~t~a~ol " :~/~//e~,~ 'l e$~ 17// <br /> ( ~ I am a regis~d ~flder <br /> ~ ~":Z ~ , ,, <br /> 4. :Fee Sch~u~ , ', <br /> A. (1) Mannfaanmd Hme ' :.: .L . ~ " <br /> or M~m Unit Plae~mffC~n~ <br /> (2) 'State Fee <br /> <br /> . ~:s~? <br /> ~, (1) Mfg.'d St~¢tum S~ge F~ ~ 40,00 ~r hou? ~ hour miMmum) <br /> ~ 525.~ =~ <br /> ~) ~g.'d S~emm S~e R~ewfl ~ 25.~ ~ :: <br /> ~) ~g Sureha~ (15.~ ffap~cabl~) ~ 15,~ = , <br /> <br />I hereby c=nffy ~hat the above information is correct and that I have read and understand th~ Informatlco Notice to Proper~y OWners about Construction Rcsponaibilities <br /> <br />NameofAppllcant(ple ~)~1:( Phone; 7~:~fi~- 7? t/taf <br />Signature of A~ppllea~t: ~ ~- Date: <br /> <br />service or plumbing water/rower lines am separate re4uired permits, MC 15-64 Rev I I-9 ! <br /> <br /> <br />