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IF. OR CITy V~LIDATION <br />ReceNed'B~: ~ :f ~ <br />Izon g V 0 .on: <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER Front: / 0 ! <br /> 285 Church St. NE - Room 132 ,City Setback Requirements: <br /> Salem, Oregon 97301 <br /> 8:00am.4:30pm Phone 588-5147 Rear: /,~ ~ <br /> 24 HR InspectionFAX g88-7948Line 588-7904 Left S d~: /l~ I Right Side: /~'- / <br /> <br />MANUFACTURED DWELLING ~(~2~ <br /> <br />COMPLETE AL <br /> <br />ALL SECTIONS, 1 THROUGH 4 l'l!,gl¥111 AI'I'L 1 L;A 1 lOIN <br />1. JOB DESCRIPTION dl!)! <br />( '~New Placement Garage o(Carpo~ <br /> ( ) Replacement (.'~.a&~ MAR/oIv <br /> ( ) Additional Unit Add-on ( ) Detached <br /> Dealers j~,.~A,,] Year of No. of Length <br /> Type of Siding: <br /> Type Roofing: <br /> (~'~) Wood ( ~Comp Square Footage:/~....~ ~-~) No. of Bedrooms: <br /> ( ) Metal ] ( ) Steel Pit Set: Energy: <br /> ( )Vinyl ( )Metal <br /> <br />2. LOCATION OF INSTALLATION ,r~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) I am the PROPERTY OWNER and own, reside ia, or will reside in th~ completed structure and will be my own general contractor. I understand that I <br /> <br />4. FEE SCHEDULE <br /> <br />I hereby cer~fy that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br />NAME OF APPLICANT (Please I~i~ .PHONE 7/~'¢- 7 ? ~9L <br />SIONATLrKE OF APPLICANT: ~DATE: */~' ~,~ <br /> <br />MC 15-64 Rev 3/x95 <br /> <br /> <br />