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MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE ~L ~%~it&~FO? OFFICE USE ONI,Yt <br /> Salem, OR 97301 ..L:~I.I I[ [* J~city Setback Re,q,i~e,,~nt*: ~ <br /> F~ 588-7948 ., ,, <br /> <br /> MANUFACTURED STRUCTURE PLA,CEMENT <br />COMPLETE ALI, SECTIONS, 1TItROUGII 4 PERMIT APPLICATION [gARii~N COUNI¥ <br />1, Job Description BUILIIlNG ~g?ECTiON <br /> <br />Commercial( ) New( ) Replacement( ) (~~ <br /> <br />Manufaetumis Year of Color of Wide; <br /> <br /> Subdiv/aion Lot J Bl~k Urban Growth goanda~7 <br /> <br />Sect~n To~s~p ~ng~ ~e : Map Water Su~ly: <br /> .............. PfivamWell ( ) Spring ( ) <br />~,~Wid~ ~ l~tm~ ] ~D Acres ~g.~[ : Comer CommgnltrWeH( ) ,aty,,.~' <br /> <br />3. Contractor Information <br /> <br />(~) I reside ~ msid~ ~ the <br /> <br />( ) I ~ be my om gme~ c~tra~or, <br /> <br /> if i him subcontractors, l will hire only subcontractors mglstered with the Comtmctinn Contractom Board, <br /> <br /> If I change my mind an~ do hire a gene/al contractor, I will comract with a ¢on~¢mr who is registered with the Constmctlon Contractors Board, and will <br /> immediately notify Marion County of the name of the contractor. <br /> <br />(~I am a registered builder OR authorized representative of a registered builder, <br /> <br />Authori~,ed agent or lessee: ) <br /> <br />4,, Fee Schedule <br /> <br />A. (1) Manufactured l-lome <br /> <br /> or Modular Unit Placemmt/Connecficm <br /> <br /> (2) S!ate Fee <br /> <br /> O) State Surcharge <br /> <br /> (4) Zoning Su<harg~ (1S,O0 if applicable) <br /> <br />B, (l) Mfg.'d Structure Storage Fee <br /> @ $25.00--__ <br />(2) /Vlfg.'d Sh"ucmm Storage R~newul @ 25,00 = __ <br />O) Zoning Surcharga (15.00 if eppllcable) @ 15,0~ ~ -- <br /> <br />C, AddBic~al hisp¢cdo~ <br /> or Aeinspcctlon <br /> <br />D. Investigation Fee <br /> <br />~, ~cr ~s~cfi~s not ~*ted <br /> ~ 40.~ ~r hour ¢ hour m~m) <br /> <br />~ $60. C~)=__ <br /> <br />@ $40,1X) =__ <br /> <br />TOTAl.-- Sr.~ -~tS'~' <br /> <br />on the%verse side of this form. <br /> <br />Name of Applicant (please print): <br /> <br /> <br />