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MARION COUNTY BUILDING INSPECTION <br />FOR OFFICE use ONLY 220 High Street NE <br />Received by: [/~ ;~ ~ [ Salem, OR 97301 <br />Zoning Validation_ t~ .... [ 8:00 ara4~$0pra l~one 58S-5147 <br /> FAX 588-7948 <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICkTION <br /> COMPLE'I'E ALL SECTK)NS, 1 TIIROUGI-I 4 <br /> <br /> FOR OFFICE USE oNLY <br /> <br />[Lef[Skte. /5't [mghtSide /J~ <br /> <br />g. L~cat~or[ of Installa6on <br /> <br />3- Contractor Information <br /> <br />( ~ ) I unde~smn6 ~at I must m~s~t as a e~;tm~ eon~a~r ff ~¢ s~a~e ii sold ~ offered f~ s~e b~o~ ~ u~ ~ple6~ <br />(~) I ~i~ be my o~ g~er~ eoat~ct~ <br /> <br />4. FCc Schedule <br /> <br />A. (1) Manufactured Home <br /> <br /> (2) State Fee <br /> <br /> (3) State Surcharge <br /> <br /> ¢) ~g-'d Smctum Storage Renewal <br /> <br /> O) 7~mg Sure~e (15..~ ff a~licab~) <br /> <br />(~ $6(/O0 = ~ .... <br /> <br /> TOTAL: $__ g. O'~er ~spec'6on~ nol 1,stea ¢0 $40cy0 = ~ <br /> ~ 40~ ~r hour (2 hour mnimm) <br />$25,~= ~, / <br /> <br /> R~CEIVL: ~ <br /> <br /> <br />