Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br /> <br />FEAR. OFFIQE ]USE O~.NLY] ,.,. 220 High Street NE <br />Rece,ved by: ~.~, 7~//~ Salem; OR 97301 <br />Zoning Validationg~ 9~_A~. _ _ I 8:00 am4;30pm phone 558-5147 <br /> <br />Date: , l~g//,-~/fffl { C°d'-A'l~n°n~588'7904FAX 588-7948 <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICATION <br /> COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> FOR OFFICE USE ONLY] <br />l~ty Setl)aqk Re/q~imments: . <br /> <br />1. Job Description <br /> <br />2, Location of Installation · <br /> <br />.. ,' ' PdvamWeH ( ) Sprig ( ) <br /> <br />3. C0ntractor in fomaatioti <br />p~f~rty Owner Mail~8 Address Phone No. "7 ~ q'~7 7/~ &! <br /> <br /> { )I undc~nd ~at ~ mus~ ~$~r as a ~st~ c~c~r ~ ~ ~tm~ is s~ oc offered for s~e b~ore or u~n ¢~plefion. <br /> <br />~ I h~ submntmcmn, I wffi ~ ~y subcon~to~ ~gist~ M~ ~e ~nstm~ C~a~n Bmrd, <br /> <br />(~) I am a ~gis~r~d buyer OR ~¢ au~ofi~6 ~senmfivc of a ~glsm~d b~d~r, <br /> <br />42 Fee S~hedule :'" <br /> <br />A. (1) Manufactured l'l~e <br /> <br /> ot Mod~ar Uni~ PlacemmffConne~ion ~ $182.00 ~.'~/~ C. Addifimal ~spectim ~ $60.~ ~a. <br /> <br />I hereby certify lhat the above infor~afion i~ eor~ct a~d ~at I ~Ve ~ad and mde~mnd ~e ~omgi~ Not{ce to ~eny Owne= ab~ C~struction Reap~sibfljties <br />~ ~e revere ~ide of ~is fo~, /~ ~ <br /> <br />TMs fee c~ers ~e man~actumd stmctua pl{~ment, plumbkg ~, d~tfi~ c~¢~im md mechanical c~ecfi~. Site evaluafim, septic pe~it, electrical <br />sem~ee or plumbing wamdmwer ~,s am se~te r~ulmd p~mits. <br /> MC 15-64 Rev 11.91 <br /> <br /> <br />