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MARION COUNTY BUILDING INSPECTION <br /> FOR'OFFIC~ USEONJ.~Y ~i.'r .~ 220 High Street NE I FOR.OFFICE USE ONLY <br />· Receivedby:~[Z~ }~'' Salem, OR973~ ~ ~ ~ }1 ~lqlS~ui~t~: <br /> <br /> ~TE ALL SEC~ONS. 1T~OUOH 4 PER~T APPLICATION ~~~~ <br /> 1. Job Descri ~on ~hRION C0UNI~ ~ <br /> <br />2. Location of Installat/on ~t~Ui//~ <br /> <br /> JobAddm8, ~7~ ff~g/~rgeff g~ z~am.N°,~77d~ ~ ..................... .~2°~st~t <br /> <br />SuMihsim ~ I Bl~k Urban Growth Boundaw? <br />.................. Commu~ty Wen { <br /> <br />3. Contractor Information <br /> <br />( ) ! own. reside in, or ~ ~eside in the completed structure, <br />( [~ under~tand that I must mgi~mr as a conatmctica~ contractor if the atmeture is sold or offered for sate before or upon completion. <br />( ) ~w~ll be my own general cont factor <br /> <br />4. Fee Schedule <br /> <br />A. (1) Manufactured I4ome <br /> <br /> or Modular Unit t lacemtmqConnecalon <br /> ~2) State Fee <br /> <br /> (4) ~ 5.00 if applicable) <br /> <br /> @ $182.00~d~'-ff~ C. Additionullmp2ctlon <br />@ 20.00 = ,.,.(2,0 ~ ~ or R 'einspection <br />@ 9.so: · q~/gl <br />@ ~ ~ J~ D- Invesfigatlor~ Fee <br /> <br />B. (1) Mfg.'d Structure Storage Fee <br /> @ $ 25.00 =__ <br /> (2) Mfg.'d Structure Storage Renewal @ 25.00 -- __ <br /> O) Zon/ng Surchaige (15.00 if applicabl~) @ 15.00 = __ <br /> <br />Oilier inspections not listed <br />@ 40.00 per hour (2 hour minimum) <br /> <br />@ <br /> <br />I hereby cenlfy that thc,qk, ove information is comet and that I have read and understand the Infomaatlon Not, ce to Property Owners about Constraetion Responslbilitle~ <br /> <br /> z/ <br /> <br /> <br />