Laserfiche WebLink
VOR 0 mC ffS LON% <br />Received b.y:~ <br />Zoning Valtdatiofi' ..~:~f~ <br /> <br /> MARION COUNTY--~IilLOI~G INSPECTION [FOR OFFICE USE ONLY_I <br /> <br /> MANUFACTUREDSTRUCTURE PLACEMENT PERMIT APPII~[4~Oi~I'~O U NTy <br /> <br />1. Job D~c~ >don <br /> <br />Residentlal(~' "' New( ~ Replacemmt( ) ( )Attached <br />Commetdal( ) New( ) Replammmt( ) ( ) Detac, hed <br />Manug;ct~mfs Ycarof ' Co;re/ Length:~_~.. "'"' WidS~ <br />Serial #: ~ ~ Manufacture, q~ [ Approved Label: ~ / / <br /> 7'/- / / '/ ..... <br /> <br />2. Location of Insmlla,ion <br /> <br /> ~tlg~r~,lA. z~r~- ~7~2.5-' site~o. . ......... <br />Su~si~ ..... ~t {.~l~ Urban Growth Bounda~7 <br />Mo~ ~,)') &eec ~n~ S~ ~ Y< <br />S~ ~ To~s~p ~ Range~' ' ~e ~ Map WaterSo~ly: <br /> ............. l'fivam Well ( ) SpCa ( ) <br /> <br />3, Contractor Information <br />?rOl:erty Own~r~t./~.O. <br /> <br />{ 'I~iaillng Address [Phone No, <br /> <br />) I own, reside in, or ~ mdde in the completed structure. <br /> <br />) I understand that I must register as a c. onstmcaon ~ontraetor g the structure is sold or offered for sale before or u[ma completion. <br /> <br />) I will be my oven general commewr. <br /> <br />If I h/xe subcontractors. I w~ him only subcont tact oi% registered with the Construction Ce~atractor~ Board, <br /> <br />I/[ change my mind and do him a general contractor, I will contract wlth a cOntractor who is registered with the Construction Contractors Boa rd, and will <br />immedhtcly notify Marion County of the name of thy contractor, <br /> <br />( ~I ara a ~'-gisteted builder OR the authorized mpresematiYe of a registered Indlden <br /> <br />4, Fee Schedule <br />A. (1) Manufactured Home <br /> or Modular Unit Placement/ConneCtion <br /> <br /> (2) State Fee <br /> <br /> (3) State Surcharge <br /> <br />B, (I) Mfg.'d Structure Storage Fee <br /> (2) Mig.'d Stmetere Storage Renewal <br /> <br /> O) Zot~g Sutebaqle (15.00 if appticabIe) <br /> <br />I hereby cerlify that the above information is concoct and that I have mad and understand the Informalio~ Not, ce to Property Owners about Construction Responsibilities <br /> <br />Signature of Applicant: $" ,-~..~a~ ~,~,, u~','-~'- -- Date: .. <br />service or plumbing water/sewer l/nos are separate requimd permits. MC 15-64 Rev I1-91 <br /> <br /> <br />