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MARION COUNTY BUILDING INSPECTION <br /> OF,FIfI .ONLYI High Street NE~i /~ ~g ~ . ~ QFHCE USE ONLY[ <br /> Received b~: <br />~ ~ng Validation~ I <br /> <br /> MA~FACT~ED STRUCT~ PL~CE~'~N~ PER~TAPPLICAT ON ~- ~ <br /> <br />:2. LocatiOn of Installation ', ¢[~;TOA3 ~ <br /> <br />S,~ t ........ , Town~p 1,,0 Range <br /> <br />3. Contractor Information <br /> <br />( )I~de~d~atlmmtm~aeo~~,~e~is~oroffe~dfor~ebdomOra~nc~pl~on. <br /> <br />If I hil~ subcontractors, ! will ~ only sub¢outractors registered with th* Construction Contractors Board. <br /> <br />If I change my mind and do him a general contractor, ! v~ll'contract with a cOnua¢/or who is registered with the Construofion Contractor's Board, and will <br /> <br />( ) I am a regxstered builder OR the authorized representauve of a registered binlder. ~T~L(~ ~ I <br />Ad~d agem or kas¢,:,, [Mailing Address: , { Phone: <br />4, Fee Schedule <br /> <br />A, (1) Mamlfaemted Home <br /> or Modular Uni~ Pheemem/Conneefion @ $18Z0O =..L~-~ <br /> (2) State P~e <br /> <br /> ($) Stat~ Surcharge ' <br /> @ 15,0o =__ <br /> (4) :~pm..n' ~$u~r~ha~if applicable) <br /> <br />B. (1) M~g,'d &memre S~otage Fee <br /> @ $ 25.0o = <br /> (2) Mfg.'d Stmcmm Storage Renewal <br /> <br /> (3) ?aanLqg Surcharge (15,00 ff appl~oablo) @ 15,00 = <br /> <br />Additional Inspection <br />or Reimpection <br /> <br />Inws~gafion Fee <br /> <br />Other ~spections not listed I ' <br />@ 40,00 per hour (2 honr mlnlmtan) <br /> <br />@ $40.0o ~. ~ <br /> <br />TOTAL= $ <br /> <br />I hereby certify that the above information is correct mad tha~ I have read and understand the Information Nolice to Property Owners about Construction Respon~ib~ties <br /> <br />s~iee or pluming wa~r/sewer ~es am se~ram r~ui~d ~its, MC 15-64 Rev 11-91 <br /> <br /> <br />