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: MARION COUNTY BUILD][b~3~I~C~[ <br />· IFOR OFFI~~LY] 220High sUeet <br />J ae~ved~ ~ ~y ~ Salem, OR ~30~11~ <br /> / Z~ing Va~d~tio~ / <br /> F~ 5Sa-794$ <br /> MANU~ACTUREffSTRUCTURE PLA~Z <br /> COYOTE ALL S~ONS, 1 T~OUOH a PER~T APPLICATION <br /> <br />FORI,O~FFIcE USE ONLYI <br /> <br />Job Descri' ~tion ./ / <br /> <br />2. Location of Ins~/lation <br /> <br />3. Contractor Information <br /> <br />(~ers~d ~at I mag ~smr as a c~s~ con~ctor ff ~ stm~ ~ sold or offc~ for sale before or u~n ~plefion. <br />( ~I ~R ~ my own gmerM contm~. <br /> <br />If I hire suboantractors, I will }Om only mb¢ontza~tors registered with ~e C~s~ C~acto~ <br />~ [ ~ge my mMd and do ~ a general ~nm~. I ~ ~a~ct ~i~ a ~ctor who is m~stcmd wi~ ~e Constmcfi~ Cmtractor's Board. ~d wig <br />~cd~ly n~y Mafi~ ~zy of ~ na~ ~ ~e <br />Contrac~r BUS~$S Name & 0: ~ I Ma~g Addgss: <br />( ) I am a r~gis~d builder OR ~e au~od~d m~smm~w of a mglst=~ <br />Au~ofi~d ~t ~ leas~: Add,ss: <br /> <br />4, Fee Schedule <br /> <br />t Phone: <br /> <br />A, (1) Manufactured Home <br />or Modular Unit Plaeem~K/Connecfion @ S182.00 = <br />(2) State Fee @ 20.00 = <br />(3) State Surcharge @ 15.00 ~. ' <br /> <br /> TOTAL: $~ <br />B, (1) M£g.'d Smmut~ Storage <br />(2) Mfg,'d Stmeturc Stet'age R~n*wal @ 25.00 -- <br />(3) Zoning Sugharg~ (15.00 if applicable) @ <br /> <br />C, Additlonalln,peetiox~ @ $60.00= <br /> or Relnspeeti0n <br /> <br />D. ~vesfigationFe~ <br /> <br />E. Other insl~m~ti~ms not lis~d <br /> @ 40.00 p~r hour (2 hoar minimum) <br /> <br /> @ $40.00 <br /> <br />RECEIPT: <br /> <br /> hereby cerfi/y that the above information is correct and that I have l~ad and tmdcratand the Information Notice to .DfopeRy Owners about Congtro~on Responsibilities <br /> the ~.~ ~i~ o~ thi~ fo= /~ -~ ~/~ cT~ <~ <br /> <br />~er~i~e or plumbi~S wated~ewer lines am ~e~ra~ r~ul~d pem{t~, MC 15-64 Rev 11-91 <br /> <br /> <br />