Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br /> <br />FOR. OFFIC~.~_US~E _~NLYI; 220 High St~ee~,~'. ;,~ n,, ~FOR OFFICE USE ONLY <br /> <br /> MANUFACTURED STRUCTURE P~E~ <br /> PER~T APPLICATION <br /> COMPI 'r S C'llONS. 1TUROUOH 4 <br /> L Job ~scfi ~flon a ' <br /> <br /> ( )Attached <br />Commcmlal( ) New( ) Replacement( ) ( ) Detached <br /> <br />Manufacturers Ycarof _, I Colorof /'~-- -- I Lmgth: J Width: <br />Serial#: ~qZ~a~C~g)~[~ Manufacture: <br /> <br /> 7q gr/e ted <br />Tax Acer. Bro. <br /> <br />Cross Street <br /> <br />$it~ No, <br /> <br />Lot 1 Block <br /> <br />Zone /~///7 Map <br />Irt~g, LOt t4/]O Comer <br /> <br />Urban Growth Boundary? <br /> <br />Water Supply: <br />.P,x/vateWell ( ) Spring <br />Communily Well ( ? Ct¥ <br /> <br />3. Contractor Information <br /> <br /> ) I own, reside in, or vail reside Jn the completed structure. <br /> <br /> ) I und~ratand that I must rggis~r as a ¢onst ruction contractor if the structure is sold or offend for sale before or upon cotnplet[oo, <br /> <br /> ) I v/ill be my own gtmeral contractor, <br /> <br />I£ I him subcontractors, I will hLr¢ only subconttaetor~ registered with the Construction Contractors Board. <br />If I change my mind and do h/t~ a general contractor, I will con.et with a contractor who is registered with the Construction Contractors Boned, and will <br />immediately notify Marion County of the name of the ¢ontradtor, <br /> <br />( ~ I aTM a registered builder OR the au~ofize~ relxesellta~ve of a regisl~r~d builder, ~// ~t~ e)~/em ¢1 7z706 <br /> <br /> /ed: 4: e- '"". <br />4. Fee Schedule ~tl/~rl'$ldd/~ Ore <br /> <br />A. (1) Mantffactumd I-Iome <br /> <br /> or Modular Unit Placement/Connection <br /> <br /> (2) State Fee <br /> <br /> (3) State Surcharge <br /> (4~Zoalng~urcn~rge Lt~-~ x~ ~ppaeable~ <br /> <br />B. (1) Mfg,'d Structure Storage Fee <br /> (2) Mfg,'d Structure Storage Renewal <br /> <br /> (3) Zoning Sumhaqge (15,00 if applicable) <br /> <br />~ $182.00-- /ffa~, ff~ C. Additionalln$pecfion @ $60.00 <br />@ 20,00 -~ ~, ~ or Re, inspection <br />@ %~0= ~./O <br />@ .,-1,.~0 D- ~v~stigationFee <br /> <br />TOTAL: $.__ <br /> <br />@ $25.00=__ <br />@ 25,00 -- __ <br />@ 1~,00 =__ <br /> <br />E. Otherinspocfions notEstetl @ $40.00 = <br /> @ 40,00 per hour (2 hour mlnimum) <br /> <br /> TOTAL <br /> <br />R~C~Irf: <br /> <br />SignatureofApplica,a: ~ / '/ Date:/~A~ <br />MC 15-64 Rev 11-9I <br /> <br /> <br />