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MARION COUNTY BUILDING INSPECTION <br />FOR OFFI. C VSE TN/t).Y I 220 High Street NI~ R[~i~[~ FOR OFFICE USE ONLY <br />Received by: ~/~2 ~/~' Salem, OR 97301 ~~~ ] <br />Zoning Validation: .... I 8:m ~.4:3~m ~ 588.5147o ~ l~l FinnY. j/ / ~ Rear, /~ <br />Date: ~ C~e-A-mme588-79~F~ 588-7948 0C[ f It~WlL~tSkd~ /fi'/ ImghtSiae~v~ <br /> MANUFACTURED STRUCTURE PLAC~Ta,a~'r~ <br /> CO~LETE ALL SEC~ONS. 1 T}mOUGH 4 PERMIT APPLICATIO~&g[~H ~a a <br /> <br /> 1. lob Description ~ ~ ~ ~ B~!ILBI~ ~¢~C~l~g <br /> <br />Commercial( ) New( ) R~heem~t( ) <br />Maa~actu~ Y~r of <br />~y~ ofSjdlng: t~B-- [:O~ '~ of R~fbg: <br /> <br />2. Location of Installation <br /> <br /> Subdivision L~ I Bl~k .......... Urban Growth Boundaw? <br /> <br /> Section To~sMp I Range Z~e Map Wamf $u~ly; <br /> ............................................... Private Well <br />~otWrd~ ],[31 ~l~h ~[I , Acres ~eg.~t Comes Commu~tyWeH( <br /> <br />3. Contractor Information <br />Prop~ayOwnet k-~k./~t~va_ L-Jd~,,e~ ~]MailingAdd~-SSl~,~5 I~,~ ~ ~PhoneNo. 7 t,q~qq <br />(~) I own, mama ~, or w ms dc ~ the e~¢eted s~c u~ <br /> <br />( ) I wit be my own g~eral eontra~or. <br /> <br />If I him subcontractors, I will him only subcomraetor~ registered with thc Construction Ccmtractom Board, <br />If I change my mind and do hire a general contractor, I will contract with a contractor who is reg4stered With the Coast, ruction Contractors Board, and will <br />immediately notify Marion County of the name of the cOntractor, <br /> <br />,, -~X') I am a rrgist~red builder~ th, Ruth otiz~ ~preseataave of a registered builder, <br />AU" thoriz~d"h~eht or fraseR, ~ '" h;iling Address, Phone: <br /> <br />A. (1) Manufactured <br />or Modular Unit Plaeemem/Conneetloa @ $ i82,00 -- <br />(2) State Fca @ 20.00 = <br /> <br /> (3) State Surchar~c @ 9,tO ~,~ <br /> 1~.00 = <br /> (4) Zoning Surcharge (15,00 if applicable) <br /> <br />B. (I) Mfg.'d Stm¢ture Storage Fcc <br /> @ $25.00=__ <br />(2) Ml-g.'d Structure Storage R~newal @ 25,00--__ <br />(3) Zoufng Surcharge (15.00 if appl/¢able) @ lS.00 =__ <br /> <br />C. Additional Inspection @ $60,00 = <br /> or Reinsp~¢don <br /> <br />D. Inveafigarion,Fc¢ <br /> <br />Oth~ inspecliona not llstcd <br /> 40.00 per hour (2 hoar minimum) <br /> <br />MC 15-64 Rev 11-91 <br /> <br /> <br />