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MARION COUNTY iBUILDING INSPECTION <br /> <br /> 220 High Street NE <br />Salem OR 97301 <br />8:00 am4:30pm le~one 588-5147 <br />Cod*-A~Phone 585-7904 <br /> FA-X 588-7948 <br /> <br />Y <br /> <br /> MANUFACTUREDSTRUCTURE PLACEMENT <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PERMI~APPLICATION <br />1, Job Description : <br /> <br />Corem,trial( ) New( ) ' i ' Replacemmt( ) ( ) Detached <br /> <br />Manufaetu~fs Year of c~r o{ Wid <br /> : qsq ........... <br /> <br />2, Location of Installation <br /> <br /> 3. Contractor Information , <br /> <br /> ) I o~, m~ide in, ~ wffi mdde M tha cm~eted <br /> ( <br /> ) <br /> I <br /> ~at <br /> <br /> If I ch~ge my m~d and do ~m a g*~r~ ~ I ~ ~ntmet ~ a c~emr who is m~md wi~ ~e ~n*tmcfi~ Cont/ae[~ Board, and will <br /> <br /> 4, Fee Schedule <br /> <br /> (2) Stat~ Fee ~ 20.~ = i ~ or <br /> (4) ~g Sum~e (1~.~ if a~licable) <br /> <br /> (2) ~g,'d Smcmm Storage Renew~ ~ ~'~ =& ~: ~ I <br /> (3) ~gSurcha~e(15,~ifa~oaNe) ~ 15,~= : I , TOTAL= $.,,~/~ <br /> <br />I her~,~y crafty.mat the above i~o~afion i~ mmct ~d ma I have ~ad and und~¢~na <br />on the. reverie s~de ~ ~ls fem. ~ : l T~ m ~x~ee to vr~eny Ownen aborn Cmstrucfio~ Respoasib~itles <br /> <br /> <br />