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MARION COUNTY BUILDING INSPECTION <br />FOR OFFICE USE ONLYI 220 High Street NI~ [FOR OFFICE USE ONLY <br />Received by: . I Saleta, OR 97301 [Oty Setback Requiremetlts: <br />Zoning Validatmn~ I &00Code. A.Pho~eam4:3Opm Pllone588_7904588-5147 [ Front: Rear: ' <br />Date: { pAX 588-7948 [L~[ Side: Right Side; <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICATION <br /> COMPLETE ALL SECTIONS. I THROUGII 4 <br /> 1. Job Description <br /> <br />2. Location of Installation <br /> <br />Subdivisi~ ~t 0 ~0~ ~ Bl~k Urban O~w~h Boundaw? <br /> Private We~ (~ Spring <br />LotWid~ ,~q¢.~Si Lot~pth ~5 Acres 3-03 I~g.I~[ Comer CommumtyW~ ) City <br /> <br />3, Contractor Information <br /> <br />own, xesifl¢ in, or x~ll reside in the completed stmctu~. ~ l <br />undemtand that [ must rogl ster aa a ¢onst~¢tioli contractor if the s,rllcture ~$ sold or offered for $a1¢ before or ul:~n completio~l, <br /> <br />will b~ my own §¢amral contractor, <br /> <br />i,mlaedjately notify Marion County of the name of the ¢ontraetog <br /> <br />A. (1) Mannfactumd Home <br />ot Moflular Unlt Plaeemem/ConneOAo~l @ $182.00=__ <br /> (2) State Fee @ 20,00 =__ <br /> (3) State Surcharge @ 9,10=__ <br /> @ 15.00 = ~ <br /> (4) Zoning Surchat&e (15,00 if applicable) <br /> <br />TOTAL <br /> <br />B. (1) Mfg.'d Stmcatfe Storage Fee <br /> @ $ 25,00 =__ <br /> (2) Mfg.'d Structure Storage Reaewal ~ 25,00 = -- <br /> (3) Zoning Sumhaege (I5.130 if appl2cable) @ 15,00 =__ <br /> <br />C, Addjdonallmpection @ $60.00= <br /> or RelnspecfiOn <br /> <br />D, investigation Fee <br /> <br />I~. Other inspections llot listed <br /> @ 40.00 per hour (2 hour mhfimum) <br /> <br /> ~ $40.00 <br /> <br />TOTAL = <br />RECEIPT: <br /> <br />I hereby certify that the above information is comet md that I have read and under~tand the haformation Notice to Property Owners about Construction l~espon ~ibilifies <br /> <br />N~me of Applicant (please print): Phone: <br /> <br /> <br />