Laserfiche WebLink
FOR OFFICE USE ONLY[ <br />Received by: <br /> / <br />ZongngValidation: <br />Date: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:00 am-4:30pm Phone 588-5147 <br /> Code-A-Phone $g8-7904 <br /> FAX 588-7948 <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICATION <br />COMPLgTE ALL SECI'ION$. 1 TIbIROUGI-I 4 <br /> <br /> Job Description <br /> <br /> FOR OFFICE USE _ONLY <br /> City Setback Requircgnents: J <br />~rOnt'. Rear', / <br />ILeft Side: R. ght Side: ~ <br /> <br />Reddenllal(~x) N~w~..) Replacement( ) Garage ot Carport <br /> ( )Attached <br />Commerdal( ) New( ) Replaeemmt( ) ( ) Detached <br /> <br />O0 t :,,.?,,z /??5 <br />~l~,pe of Siding- .' <br /> <br />2. Location of Installation <br /> <br />Su~ivision .......... I¢,~ [Bl~k Urban Growth ~ounda~? <br />Mob~e Home Park S~tce ~ Y( ) N( ) <br /> <br />Se~i~ To~sMp Range ~e Map Water Su~ly: <br /> , , PfivamWel[ ~ Spdng <br />]~tWid~ ~"~O~ Lot~hf~g,,~,,.. Aema /,gq ~;;.~t Comer Commu~tyWeU( ) City <br /> <br />If I him subaontraetOra, I will ltire ordy stlbcontraetors mgistexed with the Construction ContraO. ors Board. <br /> <br />If I ~ange my mind and do him a general contractor, I will contract wltha contractor who i~ regi~terexl with the Constm¢lion Contractors Boa~. and will <br />immedlat~ly no~y Marion County of the name of the {mntraetor. <br /> <br />: ':~ F~ Sehexqule: : : ' : : <br /> <br />A. (1) Manufacmr~ Ilome <br />or Modttlar Unit Placement/Connection @ $182.00-- <br /> <br /> , (2) State Fee @ 20.00 = <br /> @ 9.I0= <br /> (3) Stat~ Surcharge @ 15.00 --,__ <br /> (4) Zoning Surcharge (15.00 if appllmble) <br /> <br />TOTAL:S__ <br /> <br />B. (I) Mfg.'dS[metureStorageFee <br /> @ $25.00= <br />(2) Mfg.'d Structure Storage Renewal @ 25.00 =,__ <br />¢3) Zoning Surcbarge (1~.00 if applicable) @ ' 15.00 ~.__ <br /> <br />C. Additional Inspection <br /> or R~mpeetlon <br /> <br />D, Investigation Fee <br /> <br />E. Other inspections not listed <br /> @ 40,00 per hour (2 hou~ minimum) <br /> <br />$60,00:__ <br /> <br /> @ $40,00 =__ <br /> <br />TOTAL = $.__ <br />RECEIPT: <br /> <br />I hereby c~ify that the abo~a~ information is correct and that I have ~ead and undersland the IMotmation Notice lo Propeay Owners about Constr0¢tion Responsibilities <br />o~l the ~everse side of thi~ fom~. <br />Nam¢ofAppllcaat(pleaseprint): ~ ~;I[ ~ LT"~ ~ tO..,~.,~"l~ Phooe: 3~z/ ,,,9' f,,5 ,,~..~ ~Ta~'- q~r~,,c~ <br /> <br /> <br />