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MARION COUNTY BUILDING INSPECTION <br />FOR OFF, ICg USE 9NLY I :m0 I-li~h Sueet NE <br />Received by:~ { Salem, OR 97301 <br /> <br />~N(~ ~;~(~ ..... ~ [~;~R{~ COUNTY <br />2, L~afion oflns~lhdon ~ <br /> <br />FOR OFFICE USE ONLY1 <br /> <br />, Garage ~ <br /> ( wg~ttached <br /> ( ) Detached <br /> <br />?rop=rtr Own=r~..,o~z~- .,:d.o,i<~a~ m~gAdd~ss~. ~. <br /> <br />SuMi~si~ / ~ { BI~ U~an Growth Bounda~? <br />~t ~id~ ~, ~t ~h / OD Acres ~g. ~t ~0 Comer ~O Prlvam We~ ( ) Sprig ( <br /> ~mmu~y Well ( <br /> <br />Contractor Information ' <br /> <br /> ) I w~ ~ my o~ g~cr~ c~or, <br /> <br />immediately notify MariOn Co~y of th~ name of the ¢ontragto~, : { <br /> Ja3 ') 7/] <br />( ~ a regis~md ~der OR ae au~o~ m~senm~ve of a ~gism~d ~d~. <br /> <br />4. Fee Schedule ~ <br /> <br />A. (1) Manufactured Home <br /> Or Modular Unit Placeznem/Coanecfion <br /> ~) State Fee <br /> (3) State Surchazlle <br /> (4) ~ Surchalg~ (15,00 ff ap~cabl~) <br /> <br />g. (1) Mfg.'d Stm~mm $iorase Fcc <br /> ¢~) M~g.'d Stmamre Storage Renewal <br /> <br /> (~) ZOning Surcharg~ (15,00 if applicable) <br /> <br /> <br />