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FOR OF¥lCt$ USE ,o~,.~J 22o High st~t ~ ~$ ~Og <br /> OFFICE <br /> USE <br /> ONLY <br /> <br />Date:, /0- ~ ~ ] F~588-7948 }~totoe, /~j 3 ~ /~ I <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PER~T APPLICATION <br /> COYOTE ALL SEC~ON$, 1 ~OUGH 4 <br /> Job D~c~ ]ti0n <br /> <br /> him sub~ontmctom, I will ~ only gubeontracwm registered wi~ ~e Cons~on C~trac~rs Board. <br /> I~ge my m~d and ~o him a gene~l ~tm~r, I ~ ~n~et ~ a c~r who i~ m~sth~ wi~ ~¢'Con~tmcHon Cont~ctot's Board, and wi~ <br />~edia~ly no~y Mafioa Co~ty of thc name ~ ~e ~tor. <br /> <br />(~) I am a registered builder OR the authorized representative of a registetvd builder. <br /> <br />Authofiz~:d agent or leasee: ('" ,~40 <br />4; Fee Schedule <br />A, (1) ~nufa~u~dH~e or ~at Uait <br /> <br /> O) Sta~e Sumha~e <br /> (4) ~ing Sur~e (15.~ ff a~licable) <br /> <br />tL (1) Mfg.'d Structure Storage Fee <br /> @ $ 25,00-- <br />(~) Mfg,'d Structure gWrage Renewal @ 25.00 ~ <br />(3) Zo~ug Su~:harge (15,00 if applicable) @ 15,00 = <br /> <br />C. Addlrional InspeCtion $60,00 = <br />or Relnspection <br /> ', (".'i' ~ <br />D, Investigadon Fee <br /> ~,7[' ~ ~',, ~-,- ....... <br /> <br />on ih~/reverse side of this form. <br />semite or plumbing wated~ewer ~les a~ serrate ~ui~ pe~its, MC 15-64 Rev I 1,91 <br /> <br /> <br />