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MARION COUNTY BUILDING INSPECTION <br /> <br />Received by.~/0 S~em, OR 97301 <br />Zoning Validatio~ -~ ~ ~ ~. 8:~ ~m4:~ ~e 588-5147 <br /> <br />,[VOR omcE us . ONLY <br />]City Setback Requirements: . <br /> <br />]L~ft$1da: j~! ]~i$inSlde: /$ / <br /> <br /> MANUFACTURED STRUC T URF~.i'i.~&~,I~I~Tn~ <br /> PERMITAPPLICA~IOI~I bou~ i <br />~ n~c s~c~o~s. ~ T~OVd~ 4 BUILDING INSPECTION <br /> Job ~ ~fion <br /> <br /> '" Garage or Ca~port <br />~e~al( ) New( ) Replacemmt( ) ( ) Detached <br /> ,, <br />M~aetum~a Y~r o~ Color ~ W~dt <br /> <br />2. LOt'~,!iOn of Installal~ ~]ztt~tSZll,//~, ~r<, qTS~S- <br /> <br />~obAd~ 4?7 ~ar3~/ ~ . r~Am.~o. . ....c~o~s~,~ ~'SS[X <br />' q ,,, ....... <br />"Su~ ' ..... ~ I Bl~k Urban Growth Bounda~? <br />,, , PfivamWe~ ( ) Sp~Lag ( ) <br /> <br />3. Coniractor Information <br /> <br />( Y } !oYm, xeside in, or will reside in the completed strucXum. <br />( ) T understatid that I must register as a constmeaion contractor ff the structure is ~old or offered for sale before or upon completion. <br />( ) I will be my own general contractor. <br /> <br />If ~ change my ming and do h~re a general eonmctor, I will contract with a contractor who is m$1~tx:red with the ConstmctJ.oa Contractor's Board. and will <br />nnmed~ately notify Marion County of the name of the contractor. <br /> <br />(~'~am a registered builder OR the autholS~d representative of a i~gislct~d builder, <br /> <br />4.: Fee Schedule <br />A. (1) Manufactured Home <br /> or Modnlm- Uni[ Placeaneaat/Cotmomlon <br /> <br /> (2) Stite I~i <br /> <br /> O) $tate Surcharge <br /> <br />B, (1) Mfg.'d Structure- Sto~age Fee <br /> (2) IVifg.'~t Structure Storase Renewal <br /> <br /> O) .Zoning Surcharge (15.00 if applicable) <br /> <br />@ ?~_~ t~ C, Additional Inspoction <br />@ 20~00= o.~'. t'~: or Relnspection <br />@/.~ 4gae~- <br />@ ._._L.qA}~.~- ~ D. Investigation Fee <br /> <br /> TOTAL:$ ~1~,~O E, O~erinspecfioasnotllsted @ $40.00=__ <br /> @ 40,00 per hou~ (2 hour ralrdmum) <br />@ $ 25.00 = <br /> <br />@ $60.00 <br /> <br />I hereby certll~ that the above information is correct and that I have read and understand the ~lformation Notice to Property Owners about Constmctuin Responsibilities <br /> <br />Signature of Appllc~- Date: <br />service or plunthlng watedsewcr Lines are separate required permit~. MC 1 $ -64 Rev 11-91 <br /> <br /> <br />