Laserfiche WebLink
MARION !COUNTY BUILDING INSPECTION <br /> <br />I F~)R OFFIGE USE ONLY] <br />Received b.y: ~ ~ ~ <br />/ Zoning Valldat,o~-?--~k~'--~I <br />/Oate: q'-~q-q~ { <br /> <br />COMPLETI~ ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. Job Descnpt. ion ,, r . ..... glUI rllhl~ IN.~II>I:F;[I(): Garage orCa~oa <br /> ( ) At~ch~d <br /> Cmm~te~l( ) New( ) R~lac~mmt( ) ( ) <br />"M~a~tum~ ~ ~'~/~X~ Year;f ] ~]or~ ~lg~: Width: <br /> <br />2. Location of Installation <br /> <br />JobAddma~ 4,~/ ~r~/ ~r TaxAcet. Noi CrossSt~e[ ~'[X <br /> <br /> L~Wid~ ,,,',,~/ L~Depth ~ / "Ae~s [~cg,~t ~a Comer~ l'~atcWett ( ) Spring <br /> , Comumty Well { ~ City <br /> <br />3. Con,actor information <br /> <br /> ) I own, reside in. or will reside in the completed structure-. <br /> ) I undentand that I must veglster a~ a ¢onstm¢fieta conml¢~or if the st~cmi~ is sold or offered for sale bat~m or upcm completion./ <br /> ( ) I will I~ my om Sell,raJ contractor, , .~..3/g; ] <br /> <br /> If I hire subcontractors. I wfl[ ~ only subeontra~ors registered with ~he Construction Contractors Board. <br /> <br /> If ! c~hange my mind and do hire agcne, ral contractor. I will eo~tract with a contractor who ia registered with Ihe Construction Contractor'J Board, and will <br />,immeAJatelY n°tily Mafi°n C°unty 0f the name nf the oontraet°r. ~ ~¢ J~, ~___~_~/9 ~ ,,, <br /> <br />A, (1) Mannfactumd Home <br /> or Modular' Uni~ Placemont/Conne~ion <br /> <br /> (2) State <br /> <br /> O) State Surcharge <br /> <br />B, (1) Mfg,'d Struetui~ Storage Fee <br /> (2) Mfg.'d ~metom S;orage Renewal <br /> <br /> (3) Zoning Sumharge (15,00 ff applicable) <br /> <br />$182.00-- /ffRt~ G, Additionalln*pection <br />20.00 = ~ or R~specfion <br />g,t0= fi. lO <br />15.~=~Z ~ D. ~vesfigafion Fee <br /> <br /> ~ 40.~ ~r hour ~2 hour ~m~m) <br />$25.~= <br /> ~,~ = <br /> <br />@ $60. tYO = -- <br /> <br /> @ $40.00 <br /> <br />RI~CSIPT'. <br /> <br />I hereby certify that the above information is correct and that I have,read and utldemtand the Inlrormation Notice to Property Owner~ abol~t COnstructioo Respon sibklities <br /> <br />Signature of Applicant; ,~ Dale: ~ <br />service or plumbing water/sewer 1/nos are separate required permits, MC 1 $-6d Rev 11-91 <br /> <br /> <br />