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FOR OFFICE USE ONLY] <br /> Received by: ' ~"ff <br />] Zoning val~dat~ou~ ] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:00 am.4:3Opm Phorm 588-5147 <br /> C~e-A-Phone 5118-7904 <br /> FAX $88-7948 <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICATION <br />COMPLETE ALL SECTIONS. 1 TFIROUOI-I 4 <br /> <br />l, Job Description <br /> <br />2. Location of Installation <br /> <br />' $ubd'i¢isi~ m .... [BI~ , ,, Urban Growth Bounds,? <br />  Pfivat*We~ ( ) Spring ( ) <br /> <br />3, Conwactor Information <br /> <br />(~) I own, mslde ~. m ~ msldc in the ¢m~eted stm~um, <br />,( ) I u~dcrs~nd ~at I must mgis~f as a ¢onstmcti~ ¢on~ctor ff ~e stm~ ~ sold or offered for sale before or u~n c~llple0~, <br /> <br />( ) ~ wiB b~ my o~ gmeml contrast, <br /> <br />immediately notify Marion County of the name of tho contractor, <br />ContraetorBusinea, Namea#:.. _~./lct't} ~,.n.. ¥.~,,~ 3~23~ ]Mailing Acld.mx~: 11375 M. I,I ~'er)f/~, I ~'h°"~:'I~,/-9'~Vc] <br />(~t,) {,,em a reglstemd builg*r OR the authorized ~epm~entative of a regmemd builder. <br />Xuthodzcd agent or lessee;( f"t~D' ti' ~LC..tZ ~, IMailing Addmsg':,,,. i ~ ~t/.~ [l Phone;< L4/q.~r~- <br /> <br /> I <br />4. Fee Schedule <br /> <br />A, (1) Manufactured Home <br /> <br /> or Modular Unit Plaeement/CoxmeCtion <br /> <br /> (2) Stat0 Fee <br /> <br /> (3) State Surcharge <br /> <br />B, (1) Mfg.'d Stmctll~ Storage Fee <br /> (2) Mfg,'d Structure Storage Renewal <br /> <br /> (3) Zoning Sumhatge (15,00 if apphcable) <br /> <br />$I82.00= /~1~. <br /> 20.00 ~ ~ ~' ~ or R~spection <br /> <br /> ~.~: ~2gd D. Invei~ali~Fee <br /> <br /> ~ 40.00 ~r hour (2 hour m~mm) <br /> <br /> 25,~ ~ ~ TOTAL ~ <br /> <br />Natne of Applleaat (please ): <br />Signat,~mofAppUcant: ~. ~,, <br />This fee covers the manufactl~red ~(truc~re plaaelBent, plumblng connection, electrical connection <br />service or plumbing water/sewer h'~w.a/a re separate required permiIa, <br /> <br />, 'hon : <br /> <br /> MC 15-64 Kev 11-91 <br /> <br /> <br />