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,.. MARION COUNTYBUILDIJ~)~PECTION <br />FOR OFFICE' USE.ONLY 220 High Streo~/,~f-~.. FOR OFFICE USE ONLY <br />Received by:~ I Salem, OR ~ ~ ~.~/~/~e. <br />Zoning Validatiol~' ~ ~fl' a:~ am-4:3~ ~c 5~ -5~? ~/~ <br />~ . . ~ ~-/~ -O~ ~ I ~e-A-~ 588-790~d~ ~ <br />uate: ~ -~ ~ F~ 588 7948 ~ <br /> MANUFACTURED STR~$~ PdA~T ~ <br /> <br />2. Location of Installation <br /> <br />JobAddmss ~a~7' ~.~e~ ~7"-. TaxA¢¢uNo. <br />....S,~,q~<~,~ ......... ~t ~Bl~ ............. Urban Orow,h Bou~da~? <br /> <br /> Scc~on ~ TownsUp ~$ Range ~ i~al R~ Map Wa~rSu~ly: <br /> Private WcH ( ) Spring <br /> LotWidm ~/ l~Pe~ 7~/ Acres :I~eg,~t~d Comer ~ CommumtyWe~( ) <br /> <br />3. Contractor Information <br />p~op~ny owr~r~..,,,,.,.,,&~o,, .' .............. ~ I IdalangAd re;; ..... <br />( ) I own, ms/de ~, ~ ~ ~side h ~e e~eted ~um, <br />( ) I unde~mnd ~at I must m~s~r as a e~st~ eon~c~ ~ ~e s~ is sold or offe~ for sMe before or u~n comple~on. <br /> <br />4. Fee Schedule <br /> <br />A. (1) ManufaetumdHome <br /> <br /> ot iVlod ular Unit Phc~ramt/CormeOAon <br /> <br /> (2) Stat~ Fee <br /> <br /> (3) State Surcharge <br /> <br /> (4) Zon/n~ 8ur¢Imrge (15,00 it applicable) <br /> <br />B. (1) Mfg.'d Stnactul~ Storage Fee <br /> @ $ 25.00 ~.__ <br />(2) Mfg.'d S[mctum Storage Renewal @ 25.00 ~__ <br />O) ~ng Surcha~e (I5.~ if appli~ble) ~ 15,~ =__ <br /> <br />C. Additional Inspe~tlon ~o2 $60,00 = <br /> or R~Lnspect~on <br /> <br />D- lnves~ga~onFee <br /> <br />@ 40,00 per hour (2 hour rain/mum) <br /> <br /> @ $40,00 =__ <br /> <br /> TOTAL-- $ o',~/~ ~ <br /> ,cr..ipT: /bqR <br /> <br />Signammof Applicant: ~r~ Date, _,,,,,,,..~,, "7"0~ <br /> <br />This fee covers the manufactured structure plaoement, plumbing connection, e.]ectrical connecxion and mechanical connection, Site evaluation, septic permit, ele¢Ifical <br /> <br /> MC; 15-64 Re~ 11,91 <br /> <br /> <br />