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1 1rO~ITY VALIDATION <br />Rec6ived By: __ _ <br />Zonlng Validation: _ <br /> <br /> Date; ....,, <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St, NE - Roora 132 <br /> <br /> ~-i~ Inspection Line 588-7904 <br /> FAX 58S-7948 <br /> MANUFACTURED DWELLING <br /> <br />COMPLETg ALL SECTIONS, I THROUGFI 4 <br /> <br />PERMIT APPLICATION <br /> <br />1. ,lOB DESCRIPTION <br /> <br />~cFOR cIrF~y US.__E ONLY <br /> <br />( ) New PLacement ....... enrage or Carport <br />{X ) Replacement ( ) Attached <br />( ) Additional Unit Add-on ¢K ) Detached <br />Deale~ GOlC~"I W~t Year of' 1995 No. et' ~ngth Width <br />Name: ~... Mant,nmtu~r.,, Sections 3 ~ [ _, 66'... 40 <br />Ty~ of Sidi*lg: Type of Roofing: , Square F~lage: ~ 258 No, of Bcdr~ms: 3 <br /> X) Wood ~ )Comp , , <br /> <br />( ) Metal ( ) Steel ["Pit Set: Eoergy: <br />( )Vinyl ( )Metal X El~ic <br /> <br />LOCATION OF INSTALLATION <br /> <br /> 12813 Arndt Rd NE }~r,~A¢~;ount.#:l-40095-00~Cro~S,~t: n/a <br /> <br />I~mp~'nyOwn~u ~O~g F~i~ MailingAda~sg: 13193 ~dt ~ ~ Vho~ No.: 678-1261 <br />..... .. A~a,~2 <br /> 34 Township: 3S Range'. iW ~ae: ~'U Map: 3 1W 34' "678- ~61 <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />I am a CONTRACTOR registen~tl with th: State of Oregon,, , <br />~'~iling A'ddr~sa: Phone~ <br /> <br />4. FEE SCHEDULE <br /> <br />TOTAL <br /> <br />$20.00 <br /> <br />$60.00 = -- <br /> <br />t hereby certify that the above information is correct, Per,flits an:: oon-trans£crrable and expire il- work is not started within 180 days of <br /> <br /> ~'HONa 67@-1261 <br />___ _DATE'. ~'~-z-fT?5~. <br /> <br /> <br />