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MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Sf~ae~ ~ I FOR OFFICE USE ONLY <br /> <br />MANUFACTU~D~TR~~) ~ ~] <br /> PER~APPLICA~ON J .... [~'~ <br /> <br />COMPLETE ALL SgCTIONS, 1 THROUGH <br /> lob Description <br /> <br /> ( ~t~d <br />C~e~( ) Ncw( ) Rephcem~ ) ( ) D~tach~d <br /> <br />Manufacm~s Year ~ Co~ ~ ~g~: Wid~ <br /> <br />2, Location of Installation <br /> <br />3. Contractor Information <br /> <br /> ) Iowa, raaide iq, or will ~side in the cornplet6d stmarae, <br /> <br /> ) I trade.rand that I ma~t m$iamr aa a eonstm~ion cont~cta~ ff fl'm Strut{um is sold or offe.~d for sale be, fog or upOn ¢orapletlon. <br /> ) I will bo my own gt~ral eomracior. <br /> <br />4. Fee Schedule <br />A. (l) Manufaaumd Home <br /> or Modular Unit Plaeermnt/Cormection <br /> ~) Stat~ <br /> <br /> O) SLate $~h~e <br /> (4) ~ Surcha~e (~f~l~) <br /> <br /> (2) ~$,'d $~etu~ S~g~ ~newa <br /> (3) ~ng Sur~e (15.~ ff <br /> <br /> I~ I him mbcct~wv~, I ~ him only $ub¢ontractor~ r~gislered wi~ ~e ~s~a~ C~tr~m Board. <br /> ff I ch~ge my m~d ~d do M~ a genital ~c~r, I ~ ~ ~ a ~etor w~ ~ m~s~ ~ ~ C~s~cdon Contractor's Boa~, ~d wiE <br /> <br /> ( ~m a mgis~d b~er OR ag au~og~ ~s~mfiv~ of a mgismgd b~, ' <br /> <br /> Ye ~°~a~°n l~ ~ct ~d ~at I haw ~d and ~n~nd ~ Inf°~fi~ N°lce m ~o~Y Ow~ abou C~truct' - ' <br />Namc oIApp~cant ¢16a~ ~ ~ ~ ~ ~ <br /> <br /> MC I5-64 R~v I1-9I <br /> <br /> <br />