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MARION COUNTY BUILDING INSPECTION <br />FOR' OFFICE USE.ONLY] 220 High Street NE rx [FOR OFFICE USE ONLY] <br />Received by: ~.~-~ ,~d?~. / Salem, OR 97301 /~} ~ I~~ ~1 <br /> <br /> ~ANUFACTUR~D STa CT a LaC M <br /> COYOTE A~ BECKONS. 1 THROUGH 4 PER~ APPLICATIO~d~, ~ <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br />Pw~yOwner i'~ M~gAddma~ - [~oneNo. ~[ ~ <br />( ) I own, ms~e ~, ~ wffi ms~e ~ the completed stm~u~. <br /> <br />( ) I un~rs~nd ~at I must ~s~r as a c~stm~ e~tme~ ff ~e stratum is sold or offered for sale before or u~a emplefion. <br /> <br />If I hi~ sulx~ontraetor~. I will ~ only mly.~ontractor~ registered with the Construction Contractors Board. <br /> <br />If I c~hang~ my m/nd and do him a general contractor, I will con,act with a contractor who is regismmd with the Construction Contractors l~oard, and will <br />immediately notify Marion County of th~ name of rh~ contractor. <br /> <br />A~thori~d.gcntorlea,cc: ~ Likt.~.~ <br /> <br /> I <br />4, Fee Schedule <br /> <br />A, (1) Manufactured Home <br /> o~ Modular Unit Placemmt/Conne-o. ion <br /> <br /> (2) State Fee <br /> <br /> (3) State Surcharge <br /> <br />g. (1) Mfg.'d Structure Storage Fee <br /> (2) Mfg-'d Structure Storage Renewal <br /> <br /> C3) ~nlng Surcharge (15,00 if applicable) <br /> <br />· $.t,~ZO~= ,~0~,~'0 C, Additional 1top.lion @ $60.~ =_~ <br />20. - ~'~ orR~pec~ <br /> <br /> ~TAL; $ ~)~ E. ~er ins~eti~s not ~sted (~ $40,~ = -- <br /> ~ 40,00 ~ hour (2 hour mi~mm) <br /> $ 25.~ <br /> 25,~ =__ TOTAL= $,~/¢~ <br /> <br /> <br />