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MARION COUNTY BUILDING INSPECTION <br />FOR OFF.IC,,~ USE, ONL4 I 220 Higl~ [FOR OFFICE USE ONLY <br /> <br />~ ' .... [ F~'~-7948 ~ /~, _ . , - <br /> <br />P~idenlinl(X ) New~)~ ) O~rage or Carport <br />Commercial( ) N,w( ) a~Placem~l>~?C?/t.},' ( )Dc[ached <br /> <br />Manufactore~s .... Yearof . Colorof '"""It Leng~: Width: <br /> <br />2, Location of Installation <br /> <br />3. Contractor Information <br /> <br />( ) ! own, reticle in. or wi. Il resMe in the completed structure, <br /> <br />( ) I andet~tand that I mu~t register as a construction contractor if th~ stmcmm i~ sold or offered for ~ale before or upon completion. <br />( [/f~ MIl be my owa g~¢raI contractor, <br /> <br />If i change my mind and do hire a general contractor, I will contract with a clmtmctot who is reglstemd with the CotBtmctlon Contractor's BO~ ed, and will <br />immediately notify Marion Comfy of the nam~ of thc *ontractor. <br /> <br />Contmfll~r Buaingss Name & #: O Mailing Address; <br />( ~fI am a registered builder OR the authorized r~presentative of a regial~md b~lder, f <br /> <br />4. Fee Schedule <br />A. (1) Manufaetureclltom¢ <br /> <br /> (3) Stat* Sumharg~.~ <br /> ( ' , ' <br /> <br />(i) Mfg.'d Structure Storage Fee <br /> @ $25.00=__ <br />(2) Mfg.'d Structure Storage Renewal @ 25.00 =__ <br />(gl Zorfi og Su mharge (15.00 ii applicable) @ <br /> <br />C. Additional InspeCtion <br /> or Rclnspection <br /> <br />D, l~vesfigalion Fee <br /> <br /> @ 40,00 per hour (2 hour minimum) <br /> <br />@ $60.00= <br /> <br /> @ $40,00 = <br /> <br /> TO'lOlL-- $3'/~. ~ <br />~cr, Im'; lq/(~ <br /> <br />I bemby cch fy that thc above information s correct ~nd that I have read and Illlderstand the Information Notice to Property Owneri aboot Cotlstmctjon Responsibilities <br />ell the rever~e ~id~ of this form, <br /> <br />'r~, tee covers the manufactured stmclu~ pl~em~t, plumbing mnnecfi~, d~trical connection md mechanical connecbon. Site evaluation, septic pe~it, electrical <br />aemice or p umb ng waler/sewer ne~ am sepa~uimd pe~ ~ <br /> MC 15.64 Rev 11-91 <br /> <br /> <br />