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MARION COUNTY BUILDING INS.P, ECTION <br /> <br />/Received by: L Y ~,zmz-- | 2S2ZY~g' CityS~thackRequirem~t-<,, <br />~ Zoning ValidafionU. ~/h~~ [ a:00 ~m-4:30pm Phon, 555-5147 Front: <br /> FAX 55g-794S I Left Sidc; <br /> MANUFACTURED STRU CT U R ~l~Lt~lll¥ <br /> PERMIT APPLICATIIi~ <br /> 1. Job Description 751!ILBI <br /> <br />2. Location of Installation <br /> <br />Subdi~sion ~t ................ BI~ Urban Growth gounda~g <br /> <br />Scaion TownsMp Range ~mc Map Wamr Su~ly: <br /> PdvamW~ ( ) Sp~g <br />LotWid~, ,,~, ~m~ ~. Arms ~eg.~t Comer Comm~t~W~< } City <br /> <br />3, Contrac}pr Inform~ipn .~ <br /> <br />~ > l om, reside ~o, ~1 =side ~ ~e cm~e~d s=au=. <br /> <br />( ) I ~ be my own g~cr~ aontm~or, <br /> <br />If I change my mind and do hlr~ a genera contractor, I will contract with a contractor who is registered with the Construction ContraetoFs Board, md will <br />ilranedlately notify Mailon County of thc name of the contractor, <br /> <br /> I <br />4. Fee Schedule <br /> <br />A, (1) ManufaaumdHome <br /> <br /> or Modalar Unit Placement/Connection @ <br /> (2) State Fcc · @ 20.00 = ~0~' <br /> @ 9,~o = <br /> (3) State Surohagg¢ ~ 15-0O = ' <br /> (4) Zoning Surcharge (15.0O ffapplkable) <br /> TOTAL: $ <br /> <br />B. (1) Mfg.'d Stmemm Storage Fee <br /> @ $ 25.00 =__ <br />(2) Mfg,'d Stmemm Storage Renewal @ 25,00 --__ <br />O) Zoning Sumha~ge (15.00 if apptleable) @ 15,00-- __ <br /> <br />C, Additional Inspeetlon <br /> or Reinspeotion <br /> <br />D, ]hvesfigafion Fee <br /> <br />@ 40.00 I~r hour (2 hour mirdmum) <br /> <br />@ $60.00=__ <br /> <br />@ $40.0O = <br /> <br />on the rever~e side of this form. ~ <br />Name of AlSplicant (please print): d <br /> <br />This fee covers ~e manufactured sl~ct~pla~t, plumb~g ~nnec~. ~t~c~ c~ec~i~ ~d mechanical c~necfion. Site evaluation, septic pe~i~, elecleic~] <br /> <br /> <br />