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FOR. OFFICoE USEzONL¥ <br />Receivet~ by: ~ x' ~ <br />Zoning ValiCati6~ <br />Date: /~'~'~Z~'~9~ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:00 am-4:30pm Phone 588-5147 <br /> Cotle-A-Phorm 588-7904 <br /> FAX <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICATION <br />COMPLETE ALL SEC'lIONS. 1 THROUGH 4 <br />1, Job Descri }ffon <br /> <br />2. Location of Installation ~tt~.l"th//~ qzs'oT~' ' <br /> <br />3, Conwactor Information <br /> <br />( )Iown, mslde <br /> <br />immedlalely huffy Marion County of the name of thc contracton <br /> <br />4~ Fee Schedule <br />A. (1) Manufactured Home <br />or Modular Unit Plaee.m~t/Conne¢~ion @ $ I82 O0 =_ <br /> ¢) State Fee ~ ~,00 = <br /> <br />B. (l) ~g,'d Stmctut~ 5~rage <br /> ~ $ 25.~ = <br />(2) ~fg~'d ~[~c~m Sto~ag~ Renewal ~ 25.~ = <br />(3) 7anJ~g Sumha~¢ (15.~ if applicable) ~ 15.~ <br /> <br />C. Additional Inspection <~ $60,00 <br /> <br />D. ~ve.stigation Fee. <br /> <br />40.00 per hour (2 hour minimum) <br /> <br />$40.00 <br /> <br />I hereby certify that the above, in/-ormatlo~ is cOmet m~d that I have read and understand the Information Notice to Property Owne.~s about Construction Rcspon sibilitles <br /> <br />Si,natu m o, Applica'n~ .Date: ¢~/2~//5~f <br /> <br /> <br />