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gOR-~ITY VALIDATIONI MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> A~-~. ~ .... ~0 C OMMUNIT Y DEVELOP ~ME~N~R <br />Receive By' ~ ~ ~ 285 Church St NE - R City Setback R~uirements' <br /> <br />ZoningV~idation: '~[ I 8=0~m-4:30pm~one~147 1 /o <br /> <br /> FAX 588-7948 <br /> MANUFACTURED DWEL. I,,[NG 1~t97 ~ ,Je~ ~ i 4-=- <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PERMIT APPLICA~k .~/~/0N ~OUNrv <br /> <br /> L JoB DESCR ON <br /> <br /> Garage o <br />( i~New Placement ( ~o~f'~ttac he~'~'~''''~ <br />( ) Replacement <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers ~ Year of~,,~_ No. of Length Width <br />Name: ~ Manufacturer t~r7 Sections <br />Type of Siding: ~pe o~Roofing: Square Footage: <br />( I~Wood ( ~q'Comp <br />( ) Metal ( ) Steel Pit Set: Energy: <br />( )Vinyl ( )Metal ~p ~. <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> $obAddtcss: ~O~ ~tl~ <br /> T~ Account. g: <br /> <br /> Mobile Home P=k Name: <br /> ~pe~ Owner: ;O~O ~l~ Maillng Ad.ss: <br /> ~cu~t: Mailing Address: <br /> <br />ICross Street: <br /> <br /> ho. No,: <br /> <br /> Phone No.: <br /> <br /> Township: g g Rmlge: 2 ~ Zone: ~ Map: *.~ 0~j <br /> <br />3. CON~CTOR INFO~A~ON ~ PLEASE INDICATE WHO IS DOING T~ WORK <br /> ( ) I am ~e PROPER~ O~ER ~d own, reside in, or will reside in the completed stm~ and witi be my own general ~ntmctor. I unders~nd that I <br /> <br /> Cons~ction Con~acto~ Board, I wig imm~iately notify Marion ~unty of the name of the contractor. <br /> <br />Reglstration No.: <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections $245,00 = ~- ~ '-" B. Additional Inspection/ <br />(includes EL, PL ME connections) (beyond third inspection) <br />State Surcharge $12.25 = <br />State Fee $20.00 = <br /> <br /> TOTAL <br /> <br />I hereby certif7 that the above information is correct. Permits a~e non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br /> <br />SIGNATBRE OF APPLICANT: DATE: <br /> <br />MC 15-64 Rev3/95 <br /> <br /> <br />