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MARION COUNTY BUILDING INSPECTION <br />' FO~.OF.F..ICE~USE ONLY I 220 High $~ ~ . ~ a, ~ I~R O~FI~E USE ONLZ~ <br /> ZoningValidat~on~ [ S~am43~m~ 7~ ~ / " <br /> <br /> PER~T APPLICA~ON <br /> CO~LETEALLSEC~ONS, 1T~OUGH 4 ~[0N COUNTY <br /> <br />2, Location of Installation <br /> <br />_ 0cC, 3.2-g ... si,,No. .. <br />Subdivision Lot [Block Urban O~wth Bounda~'/ <br /> Pfivat~We~ ( ) Sp~g ( ) <br /> <br />3, Contractor Information <br /> <br />( ) I Un~Bd ~ag I mUSt g~smr as a ~st~ aontm¢I~ ~ ~e gtmmm is sold or ~c~ for sale bct~ro or u~n ¢~npletlon. <br /> <br />( ) I win be my o~ g~eral ~tra~. <br /> <br />~ .(~, !, I am a ~egisteted bulider OR the authorlz,~d representative of a mgism~ b~d~. <br />Au~ofi~d ag~t or leasee: X ,/~ ~{ .. /, -- ~ ~M~g AddresS: ~ ~. ~ <br /> <br />4. bee Schedule <br />^. (1) Manufactured Home <br /> or Modular Unit PIa~cm~m/Cormectioa <br /> <br /> ~) State Fee <br /> <br /> (3) ~tar~ 5~rcha~c <br /> <br />B. (1) Mfg.'d St~ctum S~rage Fee <br /> ~ $ 25,~ =.~ <br /> <br /> (3) ~g Su~ha~e <br /> <br />D. lnvesOgafion Fee <br /> <br />@ 40,00 per bout (2 hour <br /> <br />@ $60,00-- <br /> <br />@ $40,00 <br /> <br />TOTAL; $. -- <br />RECEIPT: <br /> <br />I hereby ¢ertlf¥ that the abo~,~ information is ~ ~d &at I have ~ad and unde~Mnd ~e hlfbmmtjon NoEce to ~e~y ~ne= about Constrnctlon Responaib~{ies <br /> <br />~rv~e or pmmbing w~tls~w~r lines ~ s~at~ r~ui~d pe~i~s. ~C ~ ~-6~Rev 11-91 <br /> <br /> <br />