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MARION COUNTY BUILDING INSPECTION <br />I F0~ OFFIC_~ USEONLY] 220 High Stxeet NE [FOR OFFICE USE ONLY I <br />Received b.y: ~.~ ~ zib,~c~a~[ Salem OR 97301 <br />~o~i~g ~ali~atlOff~ [ 8:~ ~:~ ~e 588-5147 <br /> F~588794~ *"' ~ [L~S~e:~/~~ []~htSide:/~ / I <br /> MANUFACTURED STRUCTURE PLACE~ <br /> COYOTE ALL $~TiONS. 1T~OUGH 4 PERMIT APPLICATION <br /> 1. Job ~Cfi ~on <br /> <br />Co~ewial( ) New( ) Replacement( ) ( ) Detached <br /> <br />3. Contractor Information " <br />Property Mailing Addm e No. <br />( ) I own, reside in, or will reside, in the completexl sta'uaure. <br /> <br />( ) I will be my own general cotura~or. <br /> <br />If I hi~ soboantraetors, I will bJ/e only subcontractors registra~l w{th ~c ~ns~i~ Cmtraem~ B~. <br /> <br />~ I ¢h~ge my m~d and do ~m a gene~l mn~a~, I ~ mntmct wi~ a c~acmr who is re~ste~ wi& ~e Cons~cfon Contrac ors BoaM. ~d w <br /> <br />~edhmlY n°ffY Mafi°n Comty of me name of ~e *one--or. ¢~¢ <br /> <br />( ~ am a regism~d bufldo~e au~ofirad mpms~ufive ~ a registered b~der. I <br />Au~od~d agent ~r~ase~ <br /> <br />4. Fee Schedule <br />A. (1) Manufactured Home <br /> or Modular Unit <br /> <br /> (2) State Fee <br /> <br /> O) State Surchat'ge /~, <br /> <br />g. (1) Mfg.'d Structure Storage Fee <br /> (2) Mfg.'d Structure Storage Renewal <br /> <br /> (3) 7x'atlng Sun,ha:ge (15.00 if applicable) <br /> <br />C, Additional Inspec~on <br /> or Rdnspection <br /> <br />D. Investigation Fee <br /> <br />E. Other ~napcctions not listed <br /> @ 40,00 ~r hour (2 hou~ minimllm) <br /> <br />@ $60.00=___ <br /> <br />@ $40,~ = -- <br /> <br />I hereby ceaify that the above information is correct and that I have md ~nd understand ~he Information Notice to Prepeny Owners about Construction Responsibilities <br />This fee covcr~ the manufactured structure pla~mcnt, plumbing COnnectie~, electrical connection and mechanical conncction. Sile evaluation, scplic permit, electrical <br /> <br /> <br />