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MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Strut NE <br /> Salem, OR §'~3~F'~ r~ ~-~ -- <br /> <br />MANUFACTURED STRU~A~ME~ <br /> PER~PLICATION~/O ~ ~S~5 <br /> <br />COMPLET!rl ALL SI~CTION$, 1 TF~OUOH 4 <br /> <br />FOR OFFICE US~E ONLY1 <br /> <br />Co~emal( ) New( ) R~h~mt( ) ( ) <br />Man~actum~$ Year ~ ~jor ~ L~g~ WJd <br /> <br />2. Location of installation <br /> <br />Job Addl~ss ~ ~/f~~ ~. , ..... ' Tax Acct. No. ~.r// /~/~t7' ~-~,:~ ~oss St~et ~// d~ F~ <br /> ...... <br />Sub.vision ......... ,,,,,,, ~ ] BI~ .... Utb~ Growth goundaw? <br />........ ., , ~ ~ Water $u~ly; <br /> PfivamWell ( ) Sp~g~ <br />LaWia* ..... ~-~ ~m~h, /OO~ dogs,,,, ~g.~t ~ Comer ~O Cmmu~ty ~a ( ) ~[y <br /> <br /> 3. Contractor Information <br /> <br /> ) I own, msld~ ['1. or will reside in the completed st~ture. <br /> <br /> ) I understand that I must register as a construction contractor ff the stnletm~ is sold or offered for sale before or trion complex/on, <br /> ) I will be my own g~aleral cemtractor. <br /> <br /> If I him subcontractors. I will him only subcontmc~om ~gistexe. d with the Conitmetion Comractom Board. <br /> If I change my mind and do h/m a general oontractor. I will contract with a cOntractor who is reg~*t~md with the Conskmetion Contractor's gourd, and will <br /> <br /> Con actor Business Name & # ....... { Mai~ng Addr¢ss: ;c [ <br /> <br /> 4. Fee Schedule <br /> A. (1) Manufa~u~dFlome <br /> <br /> D, <br /> lhvestlgat~on <br /> Fee <br /> ~ ~r,j.~. TOTAL:$J/4t'~ I::. Otherinapcefiona notlisted @ <br /> B. (1) Mfg.'d Structure, Stores; F~e i i, @ '40.00 Per hour (2 hour mln/mum) <br /> (2) Mfg.'d Structure Storage Rmcwal @ $ 25,00 =__ <br /> (3) Zoning Sur~aql~ (15 O0 ff applloabl~) @ 1.5.00 = <br /> --: RECEIPT: <br /> <br />I hereby ce-rgify that thc above information i$ {:orreat and that ~ haw read and undthe raverae side of thj~ form, 3tend the [nf°rmati°ll N°tlce t° Pt°PerrY Owners abotlI Cc~stmcr;on Rcspon~ibjhl~s <br /> <br /> <br />