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MARION COUNTY BUILDING INSPECTION <br />FOR OFFIC_~US~E ~INLY[ ~ 220 High Street NE FOR OFFICE USE ONLY <br />Received b.y:~ Salem~ OR 97301 City Se~U':k ~¢q,,i';¢ment~: <br />ZoningVahda~iofi~ I 8:~am-4:3~mm~588-5147 Fmcs: /~.~ Rear; /~ t ] <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> CO~LE'rE ALL SEC~ONS, 1 T~OUG~ 4 PER~T APPLICATION <br /> 1_ Job ~scd~on ~ <br /> <br />2. Location of installation ~ LOre <br /> <br />3. Contractor Information <br />l'~aY ow.~r ,-7~d~//~41 ~5~ e~l / ] Mailing Addres~ ~..~ ~'/~r ~- <br />(~ I own, malde in, or will reside in the completed <br />( ) I understand that i m~ls~ mgiater as a const ruction eonwactor ff the structu~ is sold or offered for sale before or xlpon completion. <br />( ) I w~ll be my owll gmleral oontracton <br /> <br />immediatelynotifyMarionCountyofthenam¢ofthe¢omractor. 'd~.Lj~6,~.~' <br /> <br /> . to ~,~,.~' ,*.~.,'~ '.r ~,r ~.. , <br />( ) ~ am a registered builder OR the au~onzed mpmsentaave ~'t~ ~g~ erEd Nd der. <br />Authorized agent or leasee: ]Mailing Address: <br /> I <br /> <br />4, Fee Schedule <br /> <br />A, (1) Manu£aetured Home <br /> or Modular Uni[ Placement/Connection <br /> <br /> (2) State Fee <br /> <br /> (3) State SumhargeA~, <br /> (4~.(x/~) ipplicable~ <br /> <br /> @ $182.00 = .l~O, gg~ C. Additional Inspection <br />@ 20.00 = a;g~. o~49 or Reinspcction <br />@ 9,10-- q,,qO <br />@ I5,00 -- ~, ~qO D, Investigation Fee <br /> <br />TOTAL: <br /> <br />B. (1) Mfg.'d Structure Storage Fee <br /> @ $25.00= <br /> (2) Mfg,'d Stmetum Stores, Renewal @ 25,00 -- <br /> ('3) Zoning Surcharge (15.00 if appLi*able) (o~ 15.00-- <br /> <br />E, Other inspections not Listed <br /> @ 40.00 per hour (2 hour minimum) <br /> <br />@ ,$60 {X~ ~ .... <br /> <br />MC 15-64 Rev 11-91 <br /> <br /> <br />