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MA RION COUNTY BUILDING <br />FOR OFFIC/E USE 9NLY 220 ttigh Stree~ <br />Zoning V~id~ ~ s:~ ~4:~ ~ ~m4* <br />Date: ~-~ ~'~V ~-A-~o~ 588-7904 <br /> <br /> MANUFACTURED STRUCTURE PL~ <br /> PER~T APPLiCATiON mr- <br /> CO~LETE ALL SEC~ONS, 1T~OUGH 4 <br /> 1. Job ~h ~fion <br /> <br />Residential( ~ New(~ Roplaecmmt( ) ..... Garage or Carport ...... <br />Commercial( ) New( ) Replacemcmt( ) ( ) Detached <br /> <br />ManufactureFs 8~ Y~arof __.... Colorof ..... /9 L~lgfil: ./.,~ h~' <br />S¢ rial #:O~/~/.~ ~dB~//~J~ Man,lecture: ~d~ [ Approved Label: ~.~¢/~_ ] ~t~r Widt <br /> <br />Location of Installation <br /> <br />3. Contractor Information <br /> <br /> ) I own, ms~d~ <br /> ) I under.nd ~at I must ~smr as a constmcfi~ ~ntmc~ ff ~e stma~ is sold or offered for sal~ b~om or u~n comp~aon, <br /> <br />K I him subcontractors, I will kite only subcontractors ~gistered with the Con~tractinn C2tatraetors Board, <br />If I change my mind and do him a general contractor, I v~ll cch'tract with a contractor who is registered with the Construction Contractors Board, and will <br />imm*dlatelY n°tLfY Marion C°mtY °, f th* name °f the c°ntraet~r' ~'~'~0 <br /> <br />( I1'"~/~ am a reglst~gd builder OR the auth°aged ~'Pmsentatlv6 °£ a reglstered builder' i~. ~gtotgl/6qIY.,2~-- <br /> <br />Fee Schedule <br /> <br />A, (1) Manufactured Home <br /> <br /> or Mo~thlar Unit Placement/Connection <br /> <br /> (2) Stat~ F~e <br /> <br /> (3) State Surcharge <br /> (%ng~ c. (l ,.004~pplicahl~ <br />B. (1) Mfg.'d Steactute Storage Fee <br /> (2) Mfg.'d Structure Storage Ren,wal <br /> <br /> (3) Zoning Sumharge (15.00 if applicable) <br /> <br />$152.00 =,/°O~, ~ C, Addi6onallnspeetlon <br />20,60 ~ ._.~, t'~ <br />9.io=~ <br />15,~ = ~ 0 D, ~ves~aaon Fee <br /> <br /> 25,00 = __ <br /> <br /> 15,~=~ <br /> <br />@ $60,1)0 <br /> <br />@ $40,00 = <br /> <br />I hereby certify that the above information is COlleCt ~d that I hav~ mad and understand the Information Notice to Property Owners about Construction Responsibilities <br />on the reverse side of this form, t ~ .. ~¢ · <br /> <br /> ._ .<'7 ' : %/q/¢ <br /> // /' <br />This fee cover~ the manufactnr~d structure placement, plumbing cormoction, electricaI eotl~l¢ction ired mechanical ¢on,qe¢llon. Site evaluation. ~epfi¢ p~rmit, electrical <br />s~rvice or plumbJng water/sewer 1/nes are separate reqnjred permits. <br /> MC I5-64 Rev 1]-91 <br /> <br /> <br />