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MARION COUNTY BUILDING INSPECTION <br /> <br />FOR OFFICg USE ONLYI 220 High Street NE FOR OFFICE USE ONLY <br />Received by, /~-,~/~w, I Salem, OR 97301 ~ ~1 <br />Z o nln. g Validationq_~ _~'~t~ } a:m ~-4:3 ~ A~ ~ 588-5147 Front: /0~ ]Rear~ ~ t"' <br /> <br /> MANUFACTURED <br /> PER~T ATION ' ~ <br /> CO~T~ ALL S~C~ONS. ~ T~OUGII 4 ~¢' <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information ~Jaod b ~rnl ? 70 7/ <br /> <br />( ) I o~. reside ~, or ~ll ~slde b ~e comple~ <br /> <br />( ) I un&m~d ~at I must m~smr as a mns~mefim g~ctor ~ ~e s~m is sold or offered for sfle before or u~n e~plefion. <br />( )IwiRbemyo~gmeml <br /> <br />If I hln~ subCOntractors. I will hire only gubcontracto~ t~gistered with the Constmclion Contractors Board. <br /> <br />ff I change my mind 8nd do him a general comraetor. I will contract with a ¢c~traotor who is registered with the Coast, mc[ion Contractor's Board, and will <br />knmediately notify Marion County of the name of the contractor. <br /> <br />( ~ am a registered buildgr OR the authorized representative of a mglstemd buildez. <br /> <br />4~e Schedule <br /> <br />A, (1) Manufactured Home <br /> <br /> (2) Stat~ Fee ~ 20.~ = ~, ~ <br /> <br /> / <br /> <br />B. (1) Mfg/d Stmcm~ Storage Fee <br /> ~ $ 25.~ ~ ~ <br />(2) Mfg,'d Stmmum S~a Renewal ~ 25.~ = ~ <br />O) ~Jng $urcha~e (15,~ if applicable) ~ 15.~ = <br /> <br />C. Additional Inspection <br /> or Reimpec6on <br /> <br />D, Investigation Fee <br /> <br />E. Other inspections not IisteA <br /> @ 40.00 per hour (2 hour roinim~m) <br /> <br />@ $60,00 ~ -- <br /> <br /> $40.00 = ..,, <br /> <br />~'o'r^L= s ~/~'t~ <br /> <br />Signatom of Appl,caot :~~~~ , Date' ~--e~-~ <br /> fee eover:~cm~; stmctu:plaL:en~, plu'=~mbing coaiecfion, electrical connection and mechallica; con:action, Site e~ahlafion, se?tic permit <br /> MC 15-64 Rev 1141 <br /> <br /> <br />