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IFOR'OFFICE USE ONLY] <br />Zomng Validation~ ~ <br /> <br /> MAroON COUNXY UULmN InSPECTiON <br /> ,..omc <br /> 8:~am-4:3~m~88-5147 ~t: ~q ~' ]Rea~: ,/~ ~ [ <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PER~T APPLICA~t~ r~ a,~. , ,t <br />CO~LB'I'E ALL SEC~ONS, 1 THROUG}I 4 ~ a,,~r~ ~ tJ ~ ( ~,, <br /> <br />Residential( L~" New( I~' Repla¢~rn~nt( ) Garage or ~rport <br /> ( )Attached <br />Commercial( ) New( ) Replaeemea~ff ) ( ) Detached <br /> <br />Manofaemmffs Year of Color of Length: Width: <br /> <br />; gubdlvisi~ Lm I ~k Urban Growth Boundau? <br />.: ....... Co~¢un(ty Wen (.) City <br /> <br /> 3, Contractor Information <br />....... P~ Ow,~ ,.},a~ e. ",* x n b° V~A~ ¢~o~;' <br /> : ( ) I own, ~side ~, or w~ reside ~ ~c eomple~ s~u~. <br /> ( ) I under.nd ~at I must ~smr as a c~stmcfi~ con~etor ff ~e s~ ia sold or offe~ for sale before or u~n c~plefi~. <br /> ~ ) I ~ ~my o~ gm~ contm~on <br /> <br />: ~edhmly n~y Marlin Corn. of the name of ~e eontra~or. <br />( ~am a registered builder OR ~e au~ofimd m~sen~five of a ~gis~md b~Mcr, : " <br /> <br />4. F¢ Schedule <br /> <br />'A. <br /> <br />(1) Manufactured Home I <br />or Modular Unit Placern~aqConnec~ion @ $182,00 = <br />(2) State Fee @ ~0,00~ ~'. OO <br /> <br />¢3) State Surchame <br />(4) Zoning Surcharge (I 5,~0 if appticable) @ <br /> <br />TOTAL: <br /> <br />(1) Mfg.'d Sta*ctum Storage <br />(2) Mfg.'d Structure Storage Renewal @ 25,00 <br />O) Zoning gurchal'ge (15.0O if applicable) @ 15,00 =__ <br /> <br />C. Addifionallnspection (cO $60.00=__ <br /> or Reinsp~efion <br /> <br />D. hwesfigaOon <br /> <br />E. Other inspections nog listed <br /> @ 40,00 per hour (2 hour mi~mwn) <br /> <br />(cO $4o~)=___ <br /> <br />Name of Applica.n (pl ~ ~ j~a.tt.9.~ Phone: 7~ - ~' ~' ~(t~ <br />MC 1f-64 Rev 11-91 <br /> <br /> <br />