Laserfiche WebLink
'FOR OFFICE USE ONLYI <br /> <br />Zoning Validatio[L~__~%/~' ] <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE FOR OFFICE USE ONLY <br /> Salem, OR 97301 ~~~ <br /> 8:00 am.n;30pm Phone 585.5147 ]Front: /~ ' IRma[! /~ ~ -~ <br /> Code-A-Phone 588-7904 Left Side' ~ t Right ~idc, g..~ t <br /> 'FAX 588-7948 [ ...........· ..5' I ' <br /> <br /> MANUFACTURED STRUCTURE PLACEMENT <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PERMIT APPLICATION <br />1. lob Descri, ,tion <br /> <br />Residential( ~f' New( ~ Repla¢~mea~[( ) ( ~)'~ttached <br /> Garage ~ Ca~ ' <br />Co~( ) New( ) R~c~mt( ) ( )Detach~ <br />Mannfaotume~ Y~r~ ~lor of Lmg~ Wid <br /> <br />I Block <br /> <br />Map <br /> <br />Cross Street <br /> <br />Urban G~owth Boundal7? <br /> ) .......... <br />Water Suppl): <br />PrlvateWeU ( ) Sprhtg <br />Comm~nityWell~ } City <br /> <br />4. Fee Schedule <br />A. (1) Manufactured Home <br /> <br /> or Modular Ul~t Place,ntm[/Counectlon <br /> <br /> (2) State Fee <br /> <br /> .~(3) State Sumhaege <br /> <br />3. ConWactor Information ~-,~/~ ~'~ ~ ~[~-'~ ~'~ ~ , <br />P~yOw~r ~ ~ ~gA~dm~s [~[~ ~ ~ [ 1" <br /> <br />( )IM~bmyo~g~e~ <br /> MARION COUN~ <br />u ~ hi~ ,.~,o~.z ~ u~ o.]y ,.~o~ ~si~ d~ ~ C~,~io. C~ s~, BUILDING INSPECTION <br />~ I ~ge my m~d and do h~m a general ~a~ I ~ ~ct ~ a c~ who is ~sm~d wi~ ~e Co~s~odon Contmc[or's ~oad, and <br /> <br />( ~ a ~gis~d buyer OR ~e au~¢ ~s~dve ora mgb~ b~d~. <br /> <br />B, (1) Mfg,'d gtmcmte Storage Fee <br /> @ $25.0o=__ <br /> (2) Mfg,'d Structure Stooge R~new~ @ 25,00 <br /> O) 7xndng Surcharge (15.00 if applicable) @ 15.00 <br /> <br />C. Additlonal Inspectlon <br /> or R~!ingpectlon <br /> <br />$60, O0 =__ <br /> <br />D. InvesfigatlonFee <br /> <br />E. Otherimpecfions not llsted <br /> @ 40.00 per hour (2 hour minimum) <br /> <br />@ $40.O0 =__ <br />TOTAL: $ <br /> <br />I hereby certify that the above information i~ correct and that I have ~ad and understand the filfotmation Notice to Property Owners about Construct/on Respon sibilifiea <br /> <br />Th~ ~** plaCement, plumbing connection, elect iical connection and mechanical connection. Site evahmtion, septic permit, electrical <br /> MC 15,64 Rev 11-91 <br /> <br /> <br />