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iir <br /> • CENED IAC , <br /> 1p0a71P RE <br /> JUN 10 2024 <br /> MARION COUNTY <br /> Linn County <br /> b� <br /> A ESSOR PO Box 100 Rm 114 <br /> ( p 300 SW 401 S7 Re 114 <br /> 1_r4 1.�)�t Albany.OR 97321 <br /> 4.s -. 1-L Phone:541-967.3016 <br /> y.'s-' ,�/.': Web:eo.linn.ocus <br /> /' Email:planoffiee@co.linn.or.us <br /> MANUFACTURED DWELLING PLACEMENT PERMIT DEPARTMENT USE ONLY <br /> APPLICATION Permit#: fa2 $ -3-4 - Obi Pic) ^ii' ' <br /> By: Date: <br /> This permit Is issued under OAR 918-440.0050. Permits expire if work is not started within 180 days of issuance or if work Is suspended for 180 days. <br /> CONSTRUCTION CATEGORY I hereby certify I have read and examined this application and <br /> y1`Manufactured Dwelling know the same to be true and correct. All provisions of laws <br /> For Mfd/RV Park,pull Area Development Permit separately and ordinances governing this type of work will be complied <br /> -for Non-Dwelling Modular Placement Permit(ie.modular with whether specified herein or not. <br /> classroom,job trailer,etc),pull Structural Permit <br /> TYPE OF WORK Applicant Signature: 5C,Urva.../614/..)----" <br /> New o Replacement o Other <br /> For work defined as addition,alteration,or repair-a REQUIRED INFORMATION <br /> Residential Structural Application would be required. Manufactured Home Siting Permit:One single permit is <br /> JOB SITE INFORMATION&LOCATION assessed to cover the installation and setup to include the <br /> Job site address: 1 Le g (\(A,i S{,t,t(t Sl,�"' ee . concrete slab,runners or foundations when prescriptive, <br /> City/State/ZIP: (V11d/l ( (TP_ �113�0 electrical feeder and plumbing connections(up to 30 lineal <br /> feet each-water,sewer,storm)and all cross-over <br /> Project Name: �-t-vi pi, I • connections. <br /> Parcel#: <br /> Directions to job site: Associated Permits:The manufactured dwelling permit does <br /> DESCRIPTION� OF WORK L' not include utility connections beyond 30 lineal feet,new <br /> tA,t:1k AkA 1W tU'tV 1'Lu�11ti1"(_1.Gt )o'[1P_ `diti ri electrical services or additional branch circuits,new <br /> Job#(optional): 1 plumbing,and other such items that fall under the building <br /> code and may require separate permits up to and including <br /> PROPERTY OWNER INSTALLATION decks,other accessory structures,and non-prescriptive <br /> Name: foundations. _ <br /> Address: Placement is: a Inside Park 44 Outside Park/Private Lot <br /> City/State/ZIP: Number of Awnings: . , <br /> Phone: Serial Number: -1)0 <br /> Email: Length: '2. Width: l <br /> ❑Owner acknowledges installation is being made on Height(original grade to highest roof point): 1.51 <br /> residential or farm property owned by me or a member-of my Year: WZ(.(- 1 Model: Stc'4 t(asi_, <br /> immediate family. This property is not intended for sale, Work being performed in Floodplain: a Vies `AN° <br /> exchange,lease,or rent. ORS 479-540(1)and 479.560(1). <br /> Signature: MANUFACTURED DWELLING FEE SCHEDULE <br /> CONTRACTOR INSTALLATION • <br /> Business name: cvlk mf-i- c.,k9,(afi1/•tIL( 'lm Mfd Dwelling Placement fee $ <br /> Address:I'‘()MR7 L(lu i L(1�1(q O JPA\M1ylDA(MA_V ci 9e Earthquake-resistant bracing $ <br /> City/State/ZIP: 5R kiln 0(C. 61136Z., system install(if applicable) <br /> Subtotal:(add up ALL fees) <br /> Phone: 6 r�t,(CI - 9j'Zcc�( 12%surcharge(,12 x subtotal) <br /> Email: ji1.lLnuf-f f'()CAIYUI,LOf . (WA" State Manufactured Dwelling Fee $30.00 <br /> Contractor CCB license#: In(DSc <br /> BCD license#: GRAND TOTAL(fees+surcharges) <br /> MDI license#: 06 ) <br /> Last revised:10/1/2018 <br />