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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE .,,.~'~,'~:,.r~. ~I~:OaF:~x~E USE ONLY <br /> S~em OR 97301 [~I[~e~l~ ~e' '~ts,. <br /> 8 ~ am-4 3~m ~o~e 588-5147~ F[~t ~ '" Rear t <br /> <br /> MANUFACTURED STRUCTURE PLACEMEN~ <br /> <br />COMPLETE ALL SECTION$. l THROUGH 4 PERMIT APPLICATION <br /> <br />Co~r~( ) New( ) R~placem~t( ) ( ) At~ch~d <br /> ( )Detached <br />Ma~amu~ ~l~ 7 ~ Year of ] '" <br /> Co~r ~ ~g~: ~ Width: <br />- ...... <br /> <br />2. Location <br /> <br /> ~-'~o,/~e ,,,dr~ ~'Tff~ si~o, ' ............ <br /> Sub~ain~ ~ }Slik .... Urban G~w~h B;unda.? <br /> <br /> Lo[ Wid~ ~ L~ De~h ~ Acres I I~g, ~t fid Comer fro ' IPfivam We~ ( ) Spring <br />.......................... Cp~mmxity We~ ( ) ~ity <br /> <br />3, Contractor Information <br /> <br /> ) I o~, =$~c ~, or wZ ~side M the comple~d szmaum. <br /> <br /> ) [ unders~nd ~at I muat m~a~r as a eonatm~m cont~etor d ~e ~tmau~ ~ sold or offered for sale before or ~n cmple~on <br /> )IwiR~myomgme~ <br /> <br />If I hire suboomraetors, I will hLre caly subcontractors r~gisteced wi~ ~e Cons~on Cm~acto~ goatd, <br /> <br />If I ch~ge my ~d and do him a geneml:~n~ctor, I ~ ~n[mct M~ a cmtmc~r w~ is m~s~md wi~ ~e Cons~c~on Contnct0r'8 go~ rd and wih <br />~O~t~ly no~y Marloa ~ty of the name of ~e ~r, ~7 <br /> <br /> ~4. s. ~ , <br /> <br />4. lee Schedule <br /> <br />A, (i) Manufactomd Home <br /> <br /> or Modular Unit Plaeem~aqConne~fion <br /> <br />B, (1) Mfg,'d Structure Storage Fee <br /> (2) Mfg.'d Structure Storage Renewal <br /> <br /> (~) Zoning Surcharge (15.00 il* applicable) <br /> <br />$I82-00=,~r_ff~ C. Additionallmpo~on @ S60.O0= <br />20,00 ~ ~7/,~, a~/~ or Reinspeefion <br />930-- <br />1~1~'~ ~, ~ <br />'iDTAL: $.1~'~t~ E. ~er ~s~cfi~s not ~$ted ~ $40.~ = <br /> ~ 40.00 ~r hour (2 hmr m~m) <br /> <br /> 1~.~= <br /> <br />MC 15-64 Rev 1t-91 <br /> <br /> <br />