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MARION C, ouJ)YrY BUILDING INSPECTION <br />FOR OFFIC~ VS~. 9NL¥1 ~ 2~0 m~~_ 1~O~ O~HC~ ~S~ ON~ <br /> <br /> COYOTE ALL SEC~ONS. 1 THROUGII n <br /> <br />2. Location of Insta~aon ,4¢~/,~/z,~ ~/~ ~703& <br /> <br />lobAdd~,s ~ //e~a ~. ~ Tax Acct. No. <br /> <br />Subdi~slon Lot ...... I'~'l~k,, Urban Owwth B'ounda~? <br /> <br />3, Contractor Information <br />.... l%l~nyOwo~r ~ ~ ~ MailMgAddr~s$ {Phon;No, <br /> ( ) I owl% ~sid~ in, ~ ~i msid~ ~ ~ cm~cmd <br /> ( ~mn~a~m~t~asac~n~tm~c~rif~es~a~i~d~r~e~df~r~b~r~nc~m~e~n` <br /> ( ) I wffi ~ my o~ 8~eral <br /> <br />immediately not&fy Marion ,Comity of the ~me of ~h¢ contractor, ]~"l/ptLAJhone <br /> <br /> or Modular Unit Placemmt/Conne~on <br /> <br /> (2) State Fee <br /> <br /> {3) State Sure, hame <br /> able) ' <br /> <br />B, (1) Mfg.*dStmcturagtorageFee <br /> (2) Mfg.'d Smlcmm Storage Renewal <br /> <br /> (~) 7~nit~g Sur~arge (t 5,00 if applieabl~} <br /> <br />@ $182,00=..~.~, ~) C. Additlonallnspectlon <br />@ 20,0Or- e~d. 0'0 orReinsp¢¢tion <br />@ 9.10= 4,,~ <br />@ ~-.~ D. [rtV~sligatlon Pee <br /> <br />@ <br /> <br /> TOTAL: $~ ~/0 Ii. Othrx i~$?~¢tion~ not lls~6 (~ $40.~ = ~ <br /> ~ 40.~ ~r hour ~ hour mlnimum) <br />$2~.~=~ <br />25.00 =__ TOTAL = $_ ~8, ~O <br /> <br />i hen:by eerqfy timt the abOve information [$ mcr ~d ~at I have mad and nnden~nd ~¢ ~lfomati~ Notice to ~ope~y Owne~ aborn Cons traction Re,pon sib~fiea <br /> <br /> <br />