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D~e~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE [FOR OFFICE USE ONLY[ <br />8:00 am.4:~0pm gh~me 588-5147 <br />FAX~SS-?948 [Lift[Side: /.~-/ IPdghtSid¢:/,5;-! J <br /> <br />i, Job Description i: - <br /> <br />2. Location of Installation <br /> <br />Subdlvisim ! i ~ I Blm~ Urban Gmwlh Bo~ndaw? <br />; , Cmmumty ~ell ( ) City <br /> <br /> 3, Contractor Information <br /> ..... ! , , <br /> (~) I o~, reside ~. ~ ~ ~alde ~ ~e cmplcmd stm~ <br /> ( ~ ) I ondc~d ~at I must m~s~r as a c~st~fi~ c~wa~o~ ff ~e s~&~ is sold or offe~ for sale b~ or u~n <br /> ( ) I wig be my o~ gmetal ~tra~or i ' <br /> <br /> If I him submntrac~m. I wffi hlrc ~y subcont~t~ mgister~ wi~ ~e ~h¢~uim ~a~ <br /> If I ch~mgc my mh~d and do ht~ a g~eral ~, I MR ~mmct ~ a c~cmr who is ~s~md wi~ ~ Constmc~on Cont~ctot'g goard, and wig <br /> ~mcd~Y no~Y Marion Csmty ~ the name ~ ~e ~amr~~ <br /> <br /> ( ~ ) I am a mgiste~d bu~er OR ~c au~od~d m~se~five of a <br /> <br /> 4. Fee Schetiule ' ' , <br /> A. (1) Manuhc~umd Hme <br /> <br /> (2) State ~ e <br /> <br /> B, (1) mfg-'dStmetumStomgeFee ~: I ~ 40.00mrhour(2h~rmi~m) <br /> <br /> (3) ~gSurc~e (15,~ifapp~ca~e) ~ 15,~=~,,'~ i <br /> <br />I hereby cc~ify ~attM above into~a,~ is ~et md ~a[ I have ~d ~d ~a~d &e ~fo~a[im No,ce to ~eRy Owa~r; abou C~s rue i~ Respoa sibilides <br /> <br />Sigm~turcofApphcant: I ~ ~]~, ' ~ . <br /> <br />scmxcc or plumbing wear/sewer lines ate s;~te t~imd ~it,. * ...... ~,?~ c~ne~z~ ~a ,necnamcaf co.cotton. Site evaluation, st:pttc peanit, electrical <br /> <br /> <br />