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MARION COUNTY BUII~~~ <br /> 220 High St~ '~ -- -- ~ ~l~l~[~R OFFICE USE ONLY] <br /> Salem, OR~{~I s~ - ~etha& gequi~e~w ] <br /> 8'~-4'3~m~SgS-5~ { ~{995 ,~ "> ,- ' , ~ <br /> F~588-7948 MARION COUNTY F~a"'- ~5 {~*s,~,,z~, { <br /> <br /> MANUFACTURED STRUCTI~IIli~8~E~Ti0 N <br />COMPLETE ALL SEC~ONS, 1 TI,mOUGH 4 PER~T AP~IC~""~ <br /> <br /> ( ) Atoned <br />C~er~( ) New( ) Rep~m~( ) ( )Detached <br />Mao~ac~Fs Y~r of Co~r ~ L~g~: Wid~ ~* <br /> <br />Location of Installation ~.~O ~.aq <br /> <br /> ...... ~ ff ~ , ...... p~- ~ .,, f ~ ' ...... <br /> ~e Map <br /> {I~,~t Wa I Comer~/~ [~mmu~tyW~( ) City <br /> <br />3. Con~ractor Information ; <br /> <br />{ fiamg Address .............. [Pholl~ No, <br /> <br />own, r~side in, or wiIl ~side in the comple~'d stmaure, <br /> <br />tm&maud that I mus~ rngi~ter as a e. onst ~lait~a contractor ff the stm~urc is sold or offered for ~ale before or upon complet/on, <br />will be my own g~eml contraclot. <br /> <br />immediately nogy Mafio~ County of the name of the eontneton <br /> <br />A, (1) IVhnufaaured Home <br />or Modular Unit PlaceanendConnection @ <br />(,2) Sa~e Fee @ 20.00 <br />(3) State Suwha/ge @ ~%1~-- <br />(4 ' <br /> <br />B, (I) Mfg,'d SirUcture Storage Fee <br /> @ $ 25.00, <br />(2) Mfg,'d Stl~lCttlre Storag~ Renewal @ 25.00 -- <br />O) Zoning Sarcharge (15.00 i~ applicable) @ 15.00 = <br /> <br />C, Additional Iospecfion (¢ $60 00 = <br /> or Reinspeefion <br /> <br />D. hvesllgation Fee <br /> <br />@ 40.00 l~r hour (2 hour mlzlimurn) <br /> <br />('~ $40,00 = <br /> <br />MC i5-64 Rev 11-91 <br /> <br /> <br />