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, MARION COUNTY BUILDING INSPECTION <br />"[ FOR OFFIC. E USE ONLY] 220 High. Street NE <br />/Received,by! ~ .¢/'~'~"~ / Salem,fOR 97301 <br />J Zoning Validation{ .// ~'~ ] 8:00 ara.4:3~O~51~.Sj_4.7, e_.r~ · <br /> <br /> OFFICE US~E ONL.__~_Y/ <br />FOR <br /> <br />2. Location of Installation ~'~7/~d~ <br /> <br /> ,! <br /> 3. Con.actor Information <br /> I ^dd.;;:" I No. <br /> <br /> ( ) I u~nd ~t I mint m~s~r as a c~st~ ¢on~c~ ~ ~ s~ is sold or offe~ for s~c b~o~ or <br /> ( )I~myo~gme~cmt~, ';:'. <br /> <br />~ I ch~g¢ my m~d and do h~ a gmcrg ~mt, I ~ ~:M~ a ~r wb 5 m~s~md ~c <br /> <br />-~i ~ a ~gism~ b~der OR ~ au~d ~s~6vc ~ a ~8is~ ~d~+ <br /> ,,,: <br /> <br />4. Fee Schedule <br />Illll I II IllI <br /> <br />A. (1) Man~fa~ut~d <br /> <br /> or Modul~ Unit Placem~ntdCormet~.on <br /> <br /> ¢) Stye F~ <br /> <br /> (3) <br /> <br />g. (1) Mfg.*d Structure <br /> (2) ~g.'d Stm~mm Storage R~ew~ <br /> <br /> O) ~ng Suw~e (15,~ ffa~h~blo) <br /> <br />TOTAL: .' <br /> <br /> 15,00 =.~ ::: <br /> I <br /> <br />@ $60.00 = -- <br /> <br />@ $40.80 = <br /> <br />I h~mby certify [hat the above ir~ormaf~on i~ correct ~a ~a[ I ~va mad ~d nn~¢-nd ~e ~o~fi~ ~-': ~ ~ · <br />on the ~ve~e side of ~is fo~. ; ::: ~ uuc~ ~ rr~c~y uwners about C~structzon Rc~p~sib~ifie~ <br /> <br /> MC I5-64 Rev 11-91 <br /> <br /> <br />