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MARION COUNTY BUILDING INSPECTION <br />FO. ON, Y REC,EIVE OFFICE ~SE ONLYI <br />Received by: ~. ~ ~ Salem, OR 97301 Ci~ <br /> <br /> MANUFACTURED STRUCTURE P~a~F~,,,,x,, '-~zA...'~ ~" h <br /> CO~L~T~AI,LSEC~ON$.ITmOUGIt4 PER~TAPPLICATIO~fim~u~n~ ]j ')~ o.~' .~'--' <br /> 1. Job Demrip~on f ~ D ~ ~ ~HILDt~ ]~$PSGTI0~ ,.. .... ~.j I./,~ -- o;/- ¢~: <br /> <br />2. Location of Installation <br /> <br />$ub~vi~i~ ~t, {Bilk Urban Growth Boundaw? <br />Mobn~ ~m~,~ ~.; ~ [ 7 ./ , <br />Sccti~ To~s~p ~ngc ~e Map Wa~r Su~/y: <br /> .... ~ PdvamWell ( ) Spring( ) <br />L~Widm ~3~t ~mpth ~ Acres I~g,~t Comer Commu~tzWea( ) City <br /> <br />3. Contractor Information <br /> ' -~ ' "l"'MaiI~g Address .... <br />r~°~tyOw"~......~9..,-,: ,a~ [-(~,,.,z;,, I~,q,q5 rS;l( (.ce_et( I~°I~e~°, 76~-72qq <br />(/~) I ow~, ~$Me in, or will m~ide in the completed stm~u~e. <br />( ) I understand that I muat m~ster as a construction contractor if th~ sttuctul~ ia ~old or offered for sale before or upon eomple[ion, <br /> <br />( ) [ wifl be my own general ~ontractor. <br /> <br /> hire subcontractors, I will ~ only subeontractOr~ registeeexl with the Comtmction Contractors Board. <br /> <br /> e, hange my mind and do hire a general cotltraotor, I will contract with a contractor who i~ registered with the Constm¢lJon Contractor's Board, and will <br />knme~Iiataly no~y Marion Cotmty of the namo of the contraeton <br /> 7 g23 3,,,,l a g )1373 <br /> <br />4, Fee Schedule <br /> <br />A. (I) Manufactured }Iomc <br /> or Modular U~it PIacem~t/ConnceIion <br /> (2) State Fee <br /> <br /> (3) State Surcharge <br /> <br /> (4) Zoning Suecha~e (15.00 ff applicabin~7~ <br /> <br />B, (I) M£8.'d Sm~ctute Storage Fcc <br /> @ $ 25.00 ~- <br />(g) Mfg/d Structure Storage Renewal @ 25.00 ~ <br />(~) Zoning Sumha~¢ (15.00 if appli~abl~) @ 15.00 ~-,__ <br /> <br />@ or Reillspcctlon <br />@ 9.10 = ._.~..~.~ , <br /> D- Invcdigation Fee <br /> <br />E, O[hex inspections not llsted <br /> @ 40,00 per hour (2 hour minimum) <br /> <br />@ $60.~ = <br /> <br />@ $40.00 <br /> <br /> <br />