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~ ~ ' MARION COUNTY BUILDIN~SPECTION <br />FOR OFFIC~ USE ~)NLY , ~ 220 High Street NI~)/¢~.. [FOR OFFICE USE ONLY <br />Received by: (~ '~5. ,4 ~-~ , Salem, OR 9730~/~ <br /> <br />~ate..._ re ~ ~ ~ F~ 58g-794~ <br /> e <br />1. Job Description <br /> <br />Res{dent[al( ~ New( ~' ~ -'4¥~ '~Gt~ ' <br /> ( ) <br />Commemial( ) New( ) Replae*m~t( ) ~ ~/~[ ( ) Detached <br /> " Width: <br />Man~actumr's Year of Color of ~g~h: ~ / <br /> <br />2. Location of Installation <br /> <br />Subdi~sion ~t IBX~ Urban O~wlh Bo~nda~? <br /> <br />3. Contractor Information <br /> <br />( ) I own, ~id¢ ~, or w~ ~slde ~ ~e ~ted stm~u~, <br /> <br />( ) I withe my own gmotfl <br /> <br />immedhtely notify Marion County of tho name of tho contractor, <br /> <br />( ~amamglsteredbuilderORtheauthofizedtepresentafiv¢ofategisteredbuild~. ~f~-/~ /~/- ~',~'. ~qm m$6t.t//~ ~f~L~ ¢~ <br /> <br />4. Fee Schedule <br /> <br />{MaillngAaar*ss:~ ~ ~q~hone: <br /> <br />A. (1) Manufactured Home <br /> <br /> or Modular Unit P[a¢¢me~l,/Ccaneet~on <br /> <br /> (2) State Fee <br /> <br /> O) State Sumba~e <br /> <br />B, (1) Mfg.'d Structure Storage Fee <br /> ¢) Mfg. g S~cmm Storage R~ew~ <br /> <br /> ~) ~ng Snmhage (15.~ ffappl~eable) <br /> <br /> @ $182,00=/~o~, ~ C. Addit~onallmpect~on <br />@ ~.~ =~. ~ o~ <br /> <br />~ - ~ 7. ~ ~ D, hvesfigafion Fee <br /> ~TAL: $ ~5~. ~ E. ~er ~s~gU~s not ~sted <br /> ~ 40.~ ~r hour (2 hour <br />~ $25~ <br />~ 25.~ ~ ~ <br /> <br />® <br /> <br /> <br />