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·' MARION COUNTY B~LDING INSPF~CTION <br />I~OR &FIC~ USE-QNLY] 220 H'~tr~ ~ US~ ONLY] <br /> <br /> ~ MANUfACTUReD ~TR~CTU~ rL~] ' <br /> <br />Location of Xns~anation od 5 tgr q 7o 7/ <br /> <br />3. Contractor Information <br /> <br />( ) I unden~d ~at I mus~ m~s~r as a constmc6~ c~c~ ~ ~¢ s~c~ is sold or off. md for s~e before or u~n c~plefion, <br />( ) I wiE ~ my o~ g~e~ c~tmcton <br /> <br />4. Fee Schedule <br />A. (1) Manufactured Home <br /> or Modular Unit <br /> (2) State Fee ~ 20.~ ='" ~2 ~ orR~s~on <br /> O) State Su~ha~ <br /> (4) 7~ <br /> <br />B, (1) Mfg.'d Stmetur~ SgOrage Fee <br /> @ $ ~,o0=~ <br /> (2) Mfgv'd Structure Storage Rettawal @ 25,00 <br /> (3) Zoning Surcharge (15.00 if applieabl~) @ 15,00 <br /> <br />Cruh~r in q:cctlons not li~terl <br /> 40.00 per hour (2 hour minimum) <br /> <br />(w_' $40.00 = -- <br /> <br />I hereby certify that the above infomlation is correct and that I have read and understand the l~formation Notice to Prolx~r~y Owners abou Constructio Responsibilities <br />on the tever~e side o~ this form, <br /> <br />This fee covers the manufactured structure placement, plumbJBg connection, el extl'i~al connection and mechanical connection, Site evaluation, scpli¢ permit, electrical <br />service or plumbing water/lOwer lines am separate required permits, <br /> MC 15-64 Rev 11-91 <br /> <br /> <br />