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MARION COUNTY BUILDING INSPECTION <br />FOR-OFFIQE USE,ONLY ~ 220 High Street NE I FOR OFFICE USE ONLY. <br /> Received by:~u- ~ Salem, OR 97301 <br />Zoning Val~atio~ _ _ , ,.. ~ ....... ~ , , . _ <br /> <br />...... : MANUFACTURED STRUCT~ PLACEMENT IU <br /> ~7~ALLSSC~ONS. iT~OU~H4 PER APPLI ON .], y I 7 1994 <br /> L Job ~scd <br /> <br />2. Location of' Irislallafion <br /> <br />3. Contractor Inf°rmafion <br /> <br />( )Io~ mstdem ~sdem~e~cmda~um.~ ,, <br />( ) I ~mnd ~at I must ~s~r as a c~stmcfi~ oon~c~ ~ ~c *~ is ~o~ or ~e~ f~ s~e befo~ or u~n c~plefion. <br /> <br />~ I ch~ge my ~d a~d do him a gene~ ~cmr. 1 ~ ~a ~ a am~c~ who ii ~sm~ wi~ ~e ~s~cfion C~tractois Boa~, and wffi <br />~edh~y no~y mfim C~. of th~ nam~ of ~e cmtr~mr, ~d <br /> <br />Au~ofi~ agent or leas~: I~g Address: ' I Phone: <br /> <br />4. Fee Schedule <br /> <br />A. (1) ManufaaureAHome <br /> <br /> or Modular Unit Plaecmmt/Co~tnectlon <br /> (2) ~ate Fee <br /> <br /> O) State Sumhaqlc ~ ~_...~, <br /> (!. ' '- ' I,--' ~.00'ifl/:lka £ <br /> <br />B. (I) Mfg.'d Stmc~ur~ Slorage Feo <br /> @ $25.00--__ <br />(2) M.fg.'d Sh'ucml~ $1omge Renewal @ 25,00 <br />O) Zoning Su~:harge ( 15.00 if applicable) @ 15,00--__ <br /> <br />C. Ad~fional Inspection @ $60,00 := __ <br />- ~r Rdnspection <br /> <br />D, Investigation Fee <br /> <br />E. Olh~r insl~¢fions not listed @ $40,00 = <br /> @ 40.00 per hour (2 hoar minimurn) <br /> <br />i hereby ~elI[fy that the above information is corrcct and that I have read a{ud tmde. mand Ihe I~-formation Notice to prOPerty O&ners about Constraction RespOn ~ibilifiea <br />on the reverie side of this form. <br /> <br />servic~ or plambing water/sewer lines am separate required pem~it$, MC 15-64 Rev 11-91 <br /> <br /> <br />