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' MARIONCOUNTYBUILDI~_,JI~-~.~'~J~]~)~ ~ V~ <br />FOR OFFI~ USE 9NLY] ,., 220 High S~t ~a~[~ ~FFICE USE ONLY[ <br />Received by: [~/~ t~ - S~em, OR 97301 g~ ~ q r: ~&~dck Req~rc~e~: <br />ZoningValidatio~ I g:~-q:3~m~g588-5147 ....... : ~ U ~V})L~rmt: ~7/ IRed;: fid/ I <br /> <br /> L Job Descfip ~a <br /> <br />3. Contractor Information <br />~o~ own~,qrrge.., t~c ,ob~ g~ ~ ~ I~ho~ No. <br />( ) I own msldc ~, or ~ msjd* ~ the commend <br /> <br />( ) I ~ be my o~ gmcr~ c~tm~on , <br /> <br />~ I him 8u~tracto~,l w~ ~ only su~ntmct~ mgistee~ wi~ ~e Cmsm~on Cmtracmrs Boar& <br />~ I eh~ge mym~d and ~o him a ge~e~ ~c~r, I wffi ~tmct wi~ a e~tmc~r who is mCsmred wi~ ~e Constm~on Contractors Board, and wi~ <br />m~m~ no~y Marlin C~y ~ ~e nme <br /> <br />Au~o~d ag~t or leasee; <br /> <br />4. <br /> Schedule <br /> <br />A. (1) ManufactumdHom¢ <br />or Modular Unig Placem~ffConn¢ction @ $182.00 <br /> <br /> (3) State Sumhargc @ 9,i0 <br /> <br />S, (1) Mfg.'d Stmctur~ Storage Fee <br />(2) Mfg/d Structure Storage Renewal @ 25.00 <br />O) Zoning Sureharg~ 05.00 i£applieable) @ 15.00 <br /> <br />C, Additional Inspection <br /> or Reinspe¢fion <br /> <br />D. hvest/gafion Fee <br /> <br />@ $60.00 := -- <br /> <br />g. Oth~ inspections not ustcd <br /> @ 40,00 per hoar (2 hour minimam) <br /> <br />@ $40,90 ~__ <br /> <br />I hereby certify ihat thc above hfformafion is correct and that I hav~ read arid understand the Information Notice Lo Proper~y Owners about Construction Responsibti/fies <br /> <br />.a.,,o,^..,,o.n, :. <br /> <br /> <br />