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iFOR~OFFI~E U~E ONLY] <br />Received by~'~.' ~f ~f~/q~ <br />Zo~tlng Validation' ~'["~' <br /> Date: / ~ ' ~- <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> o F, cE <br /> Salem, OR 97301 ] ci~ s~ Reqoirem~ts; I <br /> 8:~ am-4;3~ ~ 588-5147 · ~ <br /> C~e-A~one 58S-79~ <br /> F~ 588-7948 ' ./,,~ · <br /> <br /> MANUFACTURED STRUCTUR~PI~/xC.~EMI~NT <br />COMPLETE ALL SI~CTION~. ~ TI-IROUO~ ~ PER MIT APPLIC~I~I~, .~J/~ <br />1. Job Description <br /> <br />2. Location of Installation <br /> <br />Subdivision <br /> <br />Tax Acct. No. Crosm Street <br />Site No. <br /> <br />IBlock <br /> <br />Mag, <br /> <br /> Wamr Suppl): <br /> Private Well ( ) Sprit~g ( ) <br />}..Community Welt (..) City '~' J <br /> <br />3, Contractor Information <br /> <br />(.~I ow~, ~side ~, or ~ ~side ~ the aom~tO s~um. <br /> <br />( ) I ~ ~ my OWB gmcr~ c~tm~o[ <br /> <br />(A~uth) I am a regiam~.d builder the authorized ~eaeatailve of a registered build~. <br /> ~riz~d agent or lessee: ~ ' Ma~ng Address' <br /> ,, I <br /> <br />A. (1) Manufa~ul~dHorn¢ t ~ <br /> <br /> or Modular Unit Plaeemmt/Cormeel~on @ $I82.00= ) C, Ad~tlonallnsp~tion <br /> (2) Stat~ Fee @ 20.00 -- ~ . Of R¢~Ilspeeilon <br /> (3) Stat~Sumha~'ge @ 9.10~ ~'. ~ <br /> appllcable/_~£ ' @ i$.¢,g ~ ~ ~ D. Investigation Fee <br /> (4) <br /> 7.oning <br /> Surcharge <br /> if <br /> <br /> · TOTAL: g-x~Z~.ff E. Other in~I~ections not listed <br /> <br />B, (1) M£gJd S~ra¢tnre Storag~ <br /> @ $ 25.0~ =__ <br />(2) Mfg,'d Strac~ur~ $~orag~ Renewal @ 25.00~ <br />(3) Zoning S~rchar~z (15.00 if appHcabl~) @ 15~00 ~ ~ <br /> <br />@ $60,00 <br /> <br /> @ $40,00 = <br />40.00 per hour (2 hour n~i~hnum) <br /> <br /> TOTAL= $ <br /> RECEIPT; /'~ <br /> <br />MC 15-64 Re~ II-91 <br /> <br /> <br />