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FOR'OFFICE USE ONLYI <br />Zoning Validatio~ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE [ FOR OFFICE USE ONLY <br /> Salem, OR 97301 J~b~~ -- <br /> <br /> MANUFACTURED ErRUCT[~I]I; PLACEMENT .... <br />COMPLETEALLSECTIONS. 1TIiROUGII 4 PERMIT APPLICATION l,t~,~ [1 ] <br />I. Job DOSCrl )tion <br /> <br />Re~identlaI(~ ) Ncw(~) Replac~I*~l~*~ 1~*~ ~ ~ )~'amg~) Atuched o~ Ca~o~t <br />~merchl( ) New( ) Replacemm~' ( ) Detached <br /> <br />Manufacturers Year of Color ~ l,mgth: Wid~ <br /> <br />2. Location of Installation <br /> <br />Phon, No. 7 q <br /> <br />}'ob Add.ss <br />Subdivision <br /> <br />Mobile Home I)ark <br /> <br />Block <br /> <br />Section : ~lbwnshJp Range Zone' Map <br /> <br />Urban Growth Boundary? <br /> <br /> )N( ) <br />Wa~er Supply: <br />PfivateWell ( ) Sprblg ( ) <br /> <br />3. Contractor Information <br /> <br />( ~ ) I own, mslde in, or wffi reside ~ the competed stratum. <br /> <br />( ) I wi~ be my own gmeral c~ra~on <br /> <br />immediamly notify Marion Comty of the name of Iho contractor. <br /> <br /> ) I am a ~gtstated builder OR the authonr~d representative of a mgxst~red broider', <br /> <br />Amhori~.~d agent or leasee: <br /> <br />4. Fee Schedule <br /> <br />A. (1) Manu£ac~umd Home <br /> <br /> or Modular Unlt Plaeem~,mt/Connec'tlon @ $182,00= <br /> (2) State Fee @ 20,00 -- ~-. ~-') <br /> @ 9.~o=~/0 <br /> <br /> (4) ' '' =- . ' ' <br /> <br /> TOTAL: $.__ <br /> <br />B, (1) Mfg.'d Stmctur~ Storage Fee <br /> @ $ 25.00 =__ <br />(2) Mfg.'d Structure Storage Renewal @ 25,00 --__ <br />O) Zoning Surcha~e (15,00 if applicable) @ 15.00 -- __ <br /> <br />C, Additionallmp~cdon (~ $60,00 =__,__ <br /> or RoZn spe.¢6.on <br /> <br />D, Investigatioo F¢¢ <br /> <br />Other inspetaions not listed <br /> 40,00 per hour (2 hour minimttm) <br /> <br />@ $40,~ =___ <br /> <br /> <br />