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MARION COUNTY BUILDING INSPECTION <br />'*- I FOR OFFICE USE QNLY1 220 High Steer NE [FOR OFFICE USE ONLY <br /> / Received by:-dig~ <br /> <br /> MANUFACTURED~TRUC~ PL~M~ <br /> COYOTE ALL SEC~ONS, 1 T~OUGH 4 PER~?PPLIC ATIO~ <br /> 1. lob ~scap~n ~ARION COIJNTY <br /> <br />Commer~l( ) New( ) Rep~mt( ) ( ) Detached <br /> <br />M~ufaetu~{~ Year ~f I Colbr ~ Lmg~: ~ W~d~ 7 <br /> <br />2. Location of Installation ~o.~,~A, Z..~o$ <br /> <br />Subdi~sion ~ ~ I gl~ U~a~ Growth <br /> <br />La Wi~a ~ , ~ ~h ~ ~ ~ , Acres , I ~g~,~l~ Cornet ~ Pfiva~ Well <br /> , ,, Commu~t7 <br /> <br />3, Contractor Information <br /> <br /> ) I owo, ~side in, ot will reside in the completed stroctu:~, <br /> <br /> ) I understand that I must register as a cOtlStruot/on contrautot ff the sttllClqm is sold or offered tot sale befo~ or spun complct/oa, <br /> ) I willbe ray own aea~ral ¢~tractor, <br /> <br />If I hire subcontractors, I will him only subcontractors registerM with the Constru,aion Conttactor~ Board. <br /> <br />~ I chmge my mind and do him u general contractor, I will contract with a ~mta~tor who is registered with the ConstrUct/on Conttactoes Bo~:rd, a~d will <br /> <br /> ( ~ ~ a ~gis~red bu~er OR ae autoia ~senufive of a ~gis~d b~er, //~ ~ <br /> <br /> 4. Fee SchedFle : <br /> A, (1) <br /> ~d~rUnitPlaccm~ffC~me~on ~ ~= ~ C A4difi~flha~c~m ~ $60,~ <br /> (2) State Fee ~ 20,~; ~' ~ or R~specfion <br /> ~) agate $ureha~o ~ ~ <br /> ~ ~~ D, ~ves~ga~onFee <br /> <br /> B, (I) Mfg.'d 8~mctum $~ge Fee ,' ~ 40.~ ~r hour (2 <br /> (2) ~g,'dStmem~Sm~geg~ew~ ~ $25,~= <br /> ~ ~'~ ;: TOTAL= $~ <br /> <br />Signatu~ofAPOacant: ~ Date: ,, <br />MC 15-64 Rev 11-91 <br /> <br /> <br />