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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE -- IFOR OFFICE USE ONLY] <br /> <br /> Phone 588 <br /> 8:00 aal-4:30pm -5147 ~ ]Front: // lRear: /~/ I <br /> Cede-A-Phone 588-7904 <br /> <br /> MANUFACTURED STRUCTURE PLA0~IffNT <br /> PERMIT APPLICATION <br />COMP ETEALLSEC'iIONS, 1THROUOH 4 <br /> <br />Ta~ Acer, No. <br /> <br />Si~No, <br /> <br />Cr°sz Street )~, t ~,[ <br /> <br />Blook Urban Growth Boundary? <br /> )N( ) <br /> <br />Map Water Stlpply: <br /> Private Well ( ) Sprdlg ( ) <br />Comer <br /> <br />3. Contractor Information <br /> <br />( ) I unde~mnd ~at I must feaster aa a oonst~ em~c~r ff ~e s~uw is sold or offered for sale before or u~n cmpledon, <br /> <br />( ) I will be my om 8~era e~tm~ot <br /> <br />If I him aubeotltractor~, I will hJxe only subcontractors registered with the Construction Cott~ractora Board, <br /> <br />If ! change my mind and cio hin~ a general contractor, I wLll contract with a contractor who i~ registered with the Constrect/on Contractor's Board, acid will <br />immod~ately noilly Marion County of th, name of the contractor. <br /> <br />4, Fee Schedule <br /> <br />A. (1) Manufactomd Home <br /> or Modular Uni~ Placement/CormeClon <br /> (2) State Foe <br /> <br /> (4) ZonJ. n~Sureharge (15.00 if applicable) <br /> <br />B. (1) Mfg/d Structure Storage Fee <br /> ¢) Mfg.'d Stmeto~ StorageR~newal <br /> <br /> C3) Zoning Sul<aharge (15.00 ffappli~able) <br /> <br />MaillngAddt~-ss: 1139,3 r~, ~t ~e~,.l{ I P~oae:-~ iq .91q~4 <br /> <br />@ $60,00.~__ <br /> <br />@ $40.¢0 <br /> <br />TOTAL <br /> <br />Name ofAppl,¢ant (plea.~e prlnt,: .['1C('xa., ¢ .... /L~L(. ~,-') Phone: '7~" 7.7<'( .. <br /> <br /> <br />