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MARION COUNTY BUILDING INSPECTION <br />FOR OFFICE USE Q~I.~Y] 220 High Sueet NE FOR OFFICE USE ONLY1 <br />ZoningVahdahon' _?-~ [ 8:00am-4;30pmPhoneS$8.$147 grorlt: /~.~ Ilk;ar: t~r' ] <br /> <br />COMPLETE ALL SEC'lIONS, 1 THROUGH 4 <br />i. lob <br /> <br />( ~'~Kt t a ch e~d-~ <br /> <br />( ) Det*~h~ <br /> <br />Type of R~mg: , Footage: ///, No. Bedrooms; ~ <br /> <br />2. Location ct trion ,. .... <br /> <br />'ob A,",',,, (...0 ooA / .,r ),, ^,,,;,.. ,::,-,,.,, <br /> <br />,. ./47.~.~,'t.'~z~¢'//~' ~¢'~, ¢Td'~,?-.-f" Sit~No, , .... <br />Subdlvlslcm Lot , I Bl°ck Urban Growth Boundary? <br /> Pfivam Well ( ) Sp~Jng <br /> LotW½ath~'.~' , Lo~Delah/~ $ ~m~ Im~g, Lot ~ Com*r ~ ,, Cornmuni[yWellq ) City <br /> <br /> ContractOr ~ormatic~n , t ' ," <br /> <br /> ) I undersund ~at I must m~smr ag a ~nstmefi~ c~c~ ff ~e s~ ~ sold or offered for s~ before or u~n <br /> ~ I wiR be my o~ gCer~ oont~. ~ <br /> <br /> him subc~ntrae~m. I w~ ~¢ rely subc~t~t~ reglste~ wi~ ~e ~st~bn C~aemn B~. <br /> <br /> ~ge my m~d ~d do him a gmerfl ~nt~c~g I ~ ~ct wi~ a ~e~r who is mgis~d M~ ~e CoRsican Con raet&s Bmr. and <br />i~ediamly no~y Mafi~ ~ty of ~e name of ~ c~tr~mn <br /> <br />(~I am ~ ~fi~a~red budder OR ~e au~ofi~d ~pm,~mfive of a mgis~d b~d~, ~ .[~ <br /> <br />4. Fee Schedule <br />A. (1) Man,lfactut~d Home <br /> or Modular Un/t Placem~ml/Conn¢¢~on <br /> (2) State Fee <br /> <br />B, (1) ~g.'d S~mr¢ Storage Fec <br /> <br /> ¢) ~g,'~ S~m Sm~g~ Renew~ <br /> <br />C, Additional Impoc~on (~ ~60.C0 = -- <br /> or R~nspeX~on <br /> <br />D, Investigation Fee <br /> <br />TOTAL: $_~ <br /> <br />Other ~lspe,~fioft$ not listed <br />@ 40.00per tmur (2 hoar mhCmum) <br /> <br />@ $40,00 -- <br /> <br />TOTAL <br /> <br /> <br />