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Receiyed by:~'1 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, OR 97301 ~l~'ll/[Tl <br /> $:00 am4:30pm Phone ~$8-5147/tll-lgJ~]~ f ~'~,J <br /> Code-A-Phone 555-7904 <br /> FAX 588-/948 <br /> <br /> MANUFACTURED sTRUCTETRr I~BTMEI~; <br /> PERMIT APPLICATION '~ <br />CO~T~ ALL SEC~ONS, 1 THROUGR 4 <br />~. $o~ m~,~o. ~ O ~ ~ ~ ~A~0N COUNty <br /> <br />2. Location of Installation <br /> <br />Seclion To~s~p R~ng~ ~e Map Water Supply: <br /> .... P~vateWeB ( ) Spring ( ) <br /> <br />3. Contractor Information <br /> <br />(~) I ~sid~ in, will msJdc in th~ compl~ted <br /> ( ) I understand ~at I mast ~gist~r as a construction contractor if the sma~um is sold or ~x~cred ~or sal~ b~£or~ or ~]~,n completion, <br /> ( ) ! will b~ my own g~m~rul <br /> <br />mediately notify Marion Coumy of the name of the contractor. <br /> <br />(/~) I am a registered builder OR the authofize, d mptes~nteilve of a reglstered builder <br /> ('rc Q ................. I <br /> <br />4. Fee Schedule <br /> <br />A. (1) Manufactured Home <br /> or Modular Unit PlaeemeaVConnection <br /> <br /> (2) State Fee <br /> <br /> (3) State Surcharge <br /> <br /> (4) Zoning Surcharge (15.00 if appllcable) <br /> <br />B, (1) Mfg.'d Structure Storage Fee <br /> @ $ 25.00 =.__ <br />(2) Mfg,'d Structure Storage R~n~wal @ 25,00 =_ <br />(3) Zoalng Surcharge (15,~0 if applleable) @ 15,00 =_ <br /> <br />C, Add~tlonM Inspection <br /> Or Reln~p6etloh: <br /> <br />D, Invesdga~J. ot! F*e <br /> <br />£~ $60,~= <br /> <br />Other i~sp~ct~ons not listed <br />@ 40,00 l:¢r hour (2 hour minlmum) <br /> <br />@ $40,00 = <br /> <br />TOTAL =' $ <br /> <br />$1gnammofApplicanr ( ~.~ ~ Date: {~.-4 .2~, ta~ ~'2~, <br />'f~Js fcc eover~ the manufactured struC~ure~laCement, plumbing connection, electrical connection mud mechanical co~meclion, Site evahlation, ~ept,c permit, electrical <br /> MC 15-64 Rev 11-91 <br /> <br /> <br />