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MARION COUNTY BUILDING INSPECTION
<br /> EOR,(~FFI~_,US.~ 9..NLY1 220 Hi~F~gT~'~FOR OFFICE USE ONLY[
<br />Received bff:~ S~em~ p~ ~ [ II ICity SetMck Requirments'. I
<br />ZoningV~idatio~ I :~, 8:~am-4:3~588-5147 J ~Fm~t' 1~ ~ [Rear- /~, I
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<br /> MANUFACTURED STRUCTURE PLACEMENT
<br /> CO~mTEALLSEC~ONS. 1TUROUGH a PER~T APPLIC~N GOU~
<br /> 1, Job De~fipfion B~ILDIN~ 1~SP~IO~
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<br />Residential( ~ New( ~ ........... Repheemem( ) Garage or Carport
<br /> ( ) Attached
<br />C~e~l( ) New( ) ~heemmt( ) ( )Detached
<br />Manufacturers Year of ~lor of Wide:
<br />,~Si~ng~ 7/ ~]1 '"~ofRo~mg: ~.,,,,, [Sq. Fmmge: /Jd~ ......... IN°'gedmms: ~,,,
<br />
<br />T=^~,No.,
<br />si~ X~. ~'~7 '"''
<br />~ ,, I Bl~k ' Urban O~wth Bounda~?
<br />s~ ~ I~< > a >,
<br /> Map Water SunI5
<br />[me ~ ,, ,, [ Pfiva e We
<br /> I C°mer ~O I C°mm~tY Well f
<br />
<br />3. Contractor In. formation
<br />P roFe Ry O w n cf ,~,f~.. ~ ~g Addro$~ ]Phone No.
<br />( ) I own mslde ~, m ~ msldc ~ ~e com~eled stmaum,
<br />( ) I ~e~mnd ~at I mast m~s~r as a cmst~fim cm~or ff ~ s~am is sol~ ~ offe~ for sal¢ befo~ or u~n cmple0on.
<br />( ) I wiR be my o~ gme~ c~tra~or,
<br />
<br /> If I him subcomra¢~om, I will hit* only subcomractors reglster~d with the Construction Comractor~ Brant,
<br /> If I change my mh~d and do him a general conh-a¢[or~ I will contract with a ec~tractor who is r~gismmd with the Consu'acrlon Contractors Board, and will
<br /> immedhtelY n°fifY Max/°n,,2C°,umY of the name o~,~e 'con~trTtor. ~q,~
<br /> Contractorgufiness Name &/~:~/~s ~...~ .... ) g~'~.a,t.~.)' MailhagAddress, t//~ ~.s~rt~
<br />......... - .~-'"~-~,.~- ~,~,,*~./~, .... , '.x-----*- -- t~-~~'
<br /> ( ~ am a registered builder OR the authorized representative of a t~gis/er~d builder. ~
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<br /> 4. Fee Schedule
<br />........ ^. (i) ~u~a~a ~'
<br /> or Modular Unit Placem~lt/Conne~on
<br />
<br /> {'2) State Fcc
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<br /> (3) State $~r~ha~ge
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<br /> (4) Zoning Surcharge 05,00 ffappl/eable)
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<br />B. (I) Mfg.'d Structure Storage Fee
<br /> (2) Mfg.'d Structure Storage Renewal
<br />
<br /> (3) Zoning Surcharge (lf00ifapplicabl~)
<br />
<br />@ $60,00= ,
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<br />I hereby certify that the above informaOon is con,et and ~at I have m~d and under,nd ~e ~fo~ati~ Notice to Pr~e~y Owners about Consmtcfi~ Respon
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