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MARION COUNTY BUILDING INSPECTION <br /> <br />IFO_R OFFICE USE ONLY <br /> Received by: 2~ <br /> Zoning V~qla~ion <br /> <br /> 220 High St~ee~ ~ ~ ..., ,,. ]FOROFFICE USEONLYI <br /> . S m, OR g Itt <br /> 8:~4:~ 147 ~ ~ U ~ ~ <br /> <br />MANUFACTURED STRUCTURE PLX~g~995 ~ .... <br />MARION COUNTY D DO % I <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. lob Description Blll <br /> <br />Resi~[ential(x ) New( ) Rcplacemmt(~) ..... 'vDt'EL; I lO, ' Garage or Ca~'orr ....... <br /> ( ) Attached <br />Commerc~l( ) New( ) Replacemmt( ) ( )Detached <br /> ........ Color of th2,~ Width; <br />M:mu~actUrefa , Year of ,,, Lens~ <br /> <br />2. Location of Installation <br /> <br /> Sim No. <br />..... L~w!dtlzB,a Lan,~,,t~,~ Am, ~g.~[ ..... ~mer ~ ~ommu~tyWe~() ~ty ~ <br /> <br />3. Contractor Information <br /> <br />( ) I ovm, ~idc i~, ~' will ~id~ in <br /> <br />( ) I tmdcrstand that I must register as a cmlstluctic~ conaaetor ff the sh-uctu~ ia sokt or offered for sale begone or upon completion. <br />( X ) I will I~ my own g~ne, mle, ontractor. <br /> <br />H I kixc subcontractors, I will lfi~ <br />~ I ~ge my ~fl ~d do ~ a g~ ~c~r. I ~ ~ct M~ a c~ w~ ~ m~a~md wi~ ~e ~s~cfioa ~ntmct~s Board. and wffi <br />~edh~y no~ Mafi~ Comty ~ ~ ~e ~e ~r,; <br /> <br />( ) I ~ a mgi$~md buyer OR ~e au~ofi~d ~enmfiv* of a mgia~ ~d~. <br /> <br />Author~d agent <br /> <br /> ,,, : i IMan~g Addr**s: ........... [Phone; <br />4. Fee Schedule ,: ,, ,,, ..... <br />A, (1) Manufactured HOme <br /> <br /> ~UMt~C~e~ ~ ~=~qO ~ ~di~n~sp~fi~ ~ $60.~=_~ <br /> ~) State Fee ~ ~.~ ~ or R~s~c~ <br /> <br /> (4) ~ ~ ~~.~u D, hves~a~ ~ <br /> <br />B. (1) Mfg,'d Stmaure Storage Fe~ <br />(2) Mfg.'d $tmcmie Storage Renewal @ .25.00-- .... <br />O) Zoning Sumhar~e (15,00 if applicable) @ 15,00 =_ <br /> <br />CA~L: $~0[ f'] ~" E, Other inspe~tic~$ not listed <br /> (~ ~C~.~'~1~ @ 40.00 per hour (2 hour minimum) <br /> <br /> @ $40,00 ~ -- <br /> <br />TOTAL; $___ <br />RECFIFq': <br /> <br />I hereby certify that the above in/onmfion i~ correct ~d that I have mad ~d ~de~md ~6 ~omtim Notice t0 Pr~e~y Ownem about Cmatruction Respmsibflitie~ <br /> <br />Name of ApplJea,t ~lease ~t)~ ~.. ~ ~~ Phone: ~S~- <br /> <br /> MC 15-64 Rev 11-9I <br /> <br /> <br />