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~J-~ .................................. 1 LION COUNTY BUILDING INSPECTION <br /> EOR CITY USK ONLY..~ -- ~ ~. ~9:~ t' ~ :i]~Jl~ll~l J~l~r~)l[ VE LOPMENT CENTER <br /> <br /> Zon~g By: ~. City:~~ ~[ ~ ~egon97305 <br /> Re~ g: ~J~ ~ Amount: ~~ [ ~S:(~ 4 30 m <br /> .............. 7 ................. c ~ ~ * ¢24 m~*nspection Line 373-4427 <br /> ; MARION COONTYFAx SSS-?948 <br /> <br /> FOR CITY USE ONLY~ <br /> City Setbacks: <br /> <br /> Left: ~ Right:/.._._.~.~ <br />i <br /> <br />1. JOB DESCRIPTION <br /> <br /> RESIDENTIAL <br /> ( )New Placement ~Replacemant <br /> <br />MANUFA~IL~b ~ll~'~(]~llG PERMIT APPLICATION <br /> *fLOOR <br /> <br /> Garage or Cnrped <br /> ( )~difionalUnitAdd~n ~A~hcd ( )~thchcd Heighl: /] I <br /> <br /> No. Of Sections: ~ Len~: ~ / Width: ~t ~ght:/3t <br /> TypeofRoofing ~Comp { ISt~l [ )M~I PitSet ~ }Y ~ <br /> <br /> Num~ of BeSeems: Existing: ~ ~d: ~ <br /> <br />Typ~ of Siding: ~ Wood i ) Metal r ) Vinyl <br /> <br />Super Good Cents Home t I Yes [~ No (Provide Documentatiom <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> P.eelOwner6~~ ~ I MadthgAdd~ss:]~ ~, ~, Ciw~~ <br /> ffMobile Home P~k i) Mobile Home Subdivision ~~~Space ~ Total ~ Spas: <br /> ~P: ~G Zone: ~ [ Par~dSize: q~ (~SF ~ ) AC [UGB: ~Y t, N <br /> ~ope~ Legator [ Parcel g: g~ ~3 ~0 '] Water Supply: ( ) Private Well ~ ) Communi~ Well ~CiW <br /> <br />3. CONTRACTOR INFORMATION --- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />(} <br /> <br />1 am the PROPERTY OWNER and own. reside in. or will reside in the completed structure and will be my own general contractor, l understand th~ 1 must <br />register as a cons~uction contractor if the structure is sold or offered for ~le before or upon completion Ifl hire subcontractors. I will hire onl) subcontractors <br />registered with the Construction Contractors Board. If! change my mind and do hire a general contractor who is registered with the Construction Contractors <br />Board. I wilt imn~dialel~ rtoti~ Marion Coun~ of thc name oftb~ contractor <br /> <br />I am the AUTHORIZED REPRESENTATIVE of the prgperty owneE or the contractor, o. ~ . <br /> <br /> - --Street: ' ' :-- Zip: - Phone: <br /> <br />1 am a CONTRACTOR registered with the State of Oregon. <br />Business Name (please print): Registration #: <br /> <br /> Mailing Address: <br /> Street City: Zip: Phone: Fax: <br /> <br />4. FEES <br /> <br />A. (1) Manufactured Placement / Connections <br /> (includes EL, PL, ME connections & 30 feet <br /> each of sewer and water lines): <br /> (2) State Surcharge <br /> <br />$ 305.00 <br /> 15.25 <br /> <br /> (3) State Administrative Fee ., ~.a_ 30.00 <br /> <br />B. (1) *E~qu~e-Resis~t Bracing System (E~) $ 85.00 <br />(2) State Surch~ge 4.25 <br />(3) State A~inis~ative Fee 30.00 <br /> <br />* This fee is only charged when the ERB system is not <br />part of the original manufactured dwelling installation. <br /> <br />C. Miscellaneous Fees <br /> (1) Additional Inspection or Reinspection <br /> ~ $60/per inspection $ <br /> [Assessed for inspections beyond the third <br /> Inspection] <br /> (2) Investigation Fee ~ $305.00 $ <br /> (4) Other Inspections ~ $50 per inspecffon $ <br /> <br />TOTAL <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of <br />issuance or if work is suspended for 180 days. <br />Name of Applicant [Please Print]: ,~IA <br /> MailthgAddrcss: ' /:~O 4~),k~' q~,~:Tg.d x%AL.~'~, ~ <br /> <br />MC15-64 R~v9F)8 ( ' ( %~ ~-~ - <br /> <br /> <br />