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~., MARION COUNTY BUILDING INSPECTION <br />~'OR-OFFI(~E USE f)NLYI 220 High Street NE~ ~s~g~,~q~FOR .OFFICE USE ONLY <br />Received by:~' I { tygctbackgeqmr ents:: <br />Zoning'Valld&tio~ [~ s:~'~-4::3%~~~ ~}[~nt:; <br /> <br /> ....... M~NUF~CTURED ST~U~L~ <br /> CO~ ALL SE~ONS,, 1T~ROUGH 4 PER~T AP~ICA~ ~0,~ <br /> <br />2, Lo~ation of Installation <br /> <br />~ibdivi~i~ I Lot ' ]Bilk Urban Oro*,h goundm¢'? <br /> ' Pnvat0 Well ( ) Spnng <br /> <br />Contractor Information <br /> <br />) ] 0~ ~sldc ia,, or ~]l ~sidg ~ thc complc~d stmcium, <br /> <br />4, Fee Schedule <br /> <br />A, (i) Manufit~turcdHome <br /> or Modular Umt Placernent/COnnection <br /> <br /> (2) State <br /> <br /> (3] State Surcharge <br /> <br /> (~) ZOning Surcharge (15,130 if apphcabl¢) <br /> <br />( )Mfg.. d StrOctum Storage Fee <br /> <br />(2) Mfg..:d Structure Storage Renewal <br /> <br />(3) Zomng Sureharge (I5.00 if applicable) <br /> <br />C Additional Inspectmn <br /> or Re. ir~sve~-ion <br /> <br />D.. Invesugatiol~ Fee <br /> <br /> @ 4000 per hour {2 hour mirfimum) <br /> <br />$6000 <br /> <br />$4000 <br /> <br />I hereby c}rlit'y Ih?t the above bdormaoon i~ ~ct and Cat I have gad and undemmnd ~e ~foma ~ NotiCe o l~openy Owners ab ut <br /> <br /> <br />