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MARION COUNTY BUILDING INSPECTION <br />[FOR OF_FIC~ ~. U. S~E J~..N,~L~Y. 1 220 High Street NE ' I FOR OFFICE~ USE ONLY <br />/Rec~iveaby:-t~"~'{ Salem, OR97301 ..,~ _ .~ O~s~gequirmenLq: <br /> <br /> F~ 58S-7948 I~, -~r [ Right $ide.~ <br /> MANUFACTURED STRUCTU~ ~A~'F~ ~ <br /> tmMP~T~A[LSEC~O~S,~T)mOUOR4 PERMITAPPLICA~ON ~r.~p O O ~ <br /> <br />.... S No. <br /> Se~ ~,,~ ~o~shp,,,,~5 Ra.g, ~ ., ' Map <br /> l,~Wid~ 7~,~ L~De~h B/ A~= ~g.u~ YeS i Com,r leg '" Vfiva. We]] ( ) Sp~g( <br /> , ...... Cmmu~ty Well ( ) City <br /> <br />3, Contractor Information <br />Property Owner ~ ~ ~ MaiIingAddres~ [Phone'No. ' .... <br /> <br />( ) I own, reside in, or will reside in the completed structure. <br />( ) ! undea's tgqd that I must register as a ¢onstmndm contractor if the structure is sold or offered for sale bek, re or upon ¢omplellom <br />( ) ~ will be myown gmeral contractor. <br /> <br />If I hire subcontractoe3, I ~ him only subcontractor* rcgistarexl with the Construction Contractors Board, <br />: I/I Change my mind and do hi~ a general contractor, ~ will contract wi~h a ctmtraetOr who is registered With the'Constm¢llon Contractor's Board ~md will <br />itrmlethately not~T Marion County of th~ name of the contractor. <br /> <br />( ~I van a regi~l~red builder OR the authorized repmaentat~ve of a registered builder, <br /> <br /> ./ , <br /> <br />4, Fee Schedule <br /> <br /> A. (1) Manufactu~d Home <br /> <br /> or Modular Unit Plaeemea~I/Ceomcctlon <br /> <br /> (2) State Fee <br /> <br /> (3) State $ugha~e <br /> <br />B. <br /> <br /> ¢) Mfg.'d $~[um Sm~ge R~wal <br /> <br />@ $60.00=__ <br /> <br />TOTAL: $ ,'ff-:~t~-J/~ E, Other inspections not llst,d @ <br /> @ 40.00 per hour (2 hour minLmum) <br /> 25.00 =__ <br /> <br /> 15,00=__ <br /> <br />I hereby ccnlfy that the above information is correct and that I have read and understand the InformatAon Notice to Property Owners about Construction Responxlblthie, <br /> <br /> MC 15-64 Rev 11-91 <br /> <br /> <br />