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.FOR OFFIC~ ~$~E q,~.,.L_Y]/ <br />Received by:-~7~~ <br />Zoning VaHd~t~~ ~ <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE FOR OFFiCE USE ONLYI <br /> Salem, OR 97301 I CRy Sexback <br /> 8;00 ~n-4:30pm Phone 558-5147 Lpr°nt: i~ ! [Rear: /~ / [ <br /> Code-A-Phone 558-7904 [ L~fft Side: <br /> FAX 5$g-79a$ <br /> MANUFACTURED STRUCTURE PLACEMENT <br /> PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 TI4ROUGH 4 <br />1, Job DCS¢~ <br /> <br />Rcsldontial( ~ New( '~' Repla¢~rne~nt( ) Garage or CaWon <br /> ( ) At~che~ <br />~e~al( ) New( ) ' R~e~t( ) ( ) Detached <br /> <br />M~faemm~s Year of ~lor of ' <br /> <br />Sub~i~ ~ ' I ~t ] Bilk Urban Growth Bounda~? <br /> ., C~nmumtgw~l~ ~ City <br /> <br /> If I him sub~nwactor% l will ~ only subcontractors mgJstexed with the Construction Contractors BeanS, <br />If I e~hange my mind and do him a goneral contractor, I will contract with a eomractor who is mgistere4 With the Constracrion Contractors Boae~, and will <br />~rara¢6~aV:ly n0t~y Marion Co,mt), of %he name of the comtacto~, ~:9,~ ~9 O'/Q ' <br /> <br /> ( ~ am a mgisu:md builder OR thc authorized representative of a registe, md builder, <br /> <br />4. Fee Schedale <br />A, (1) Matmfa~,umd Rome <br /> or Modular Unit Placemen~/Conncction <br /> <br /> (2) State Fee <br /> <br /> (3) State SurceaSe <br /> <br />g, (1~ Mfg.'d Stmc~m Storage <br /> (2) ~g/d Stmemm Stomg~ R~ewa[ <br /> <br /> (3) ~nlng Sumha~e (15,~ if <br /> <br />$182,00=/~,~ C, Additionalln~pectio~ @ $60,00 = <br />20,00~ ~F/~. ~1 orR~spe~on ': <br />940 = R/~ : <br />~ ~ D. ~vesfiga~onFee <br /> <br /> ~ 40.~ ~r hour (~ hoot ~mum) <br />$ 25,~=~ <br />25.~' ' TOTAL= <br />~5.~=~ <br /> <br />Slgnatu re o f Applican[; <br /> <br /> <br />