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trOll CITY V.~LII)A./I~ION[ <br />Received By: ~] <br />Zoning Validation: ~_~_~! <br />Date: .._~ ] <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. JOB DESCRIPTION <br /> <br /> ( ) Replacement <br /> ( ) Addifion~ Unit <br /> <br /> Typ~ of Siding: <br /> ( <br /> ) Metal <br /> ) Vinyl <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St. NE - Room 132 City S~thack Requirements: <br /> Salem, Oregon 97301 <br /> 8.'~-4:30pm Phone 588-5147 Front: /~ # .~___t <br /> ~AXSS~-7~aS /l]l)~f,~_ ' /,.~' <br /> MANUFACTURED D~~'~' ~ r~--f'~ <br /> PERMIT APPLICA~J~ .~ -- %/!/I <br /> ( )Detached <br /> <br /> T <br />Year of / No. of / Length Width <br />Manufacturer ~7 Sections ~ ept. ~) ~--7 <br /> Square Footage:/~ No. of Bedrooms: ~ <br /> <br />Type of Roofing: <br /> S~omp <br /> ) Steel <br /> ) Me~al <br /> <br />Pit Set: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Job <br /> Addr~s: <br /> <br /> ~ MalUng Ad~s: L <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) must reglet~r as a construction conh-actor if the structure is sold or offered for sale before or upon completion. If I hire subeomractors, I ,.viii hlr~ only <br /> subcontractors registm~i with the Construction Coati-actors Board. If I change my mind and do hire a g~neral ~omractor who is r~gistered with the <br /> <br />4. FEE SCHEDULE <br /> <br />Additional Inspection/ <br />(bcyond third inspexiion) <br />Reinspection Fcc <br /> <br />I hereby certify that the abow 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 150 days. <br />NAME OF APPLICANT (pleas~~ 3 _~O~'.~ <br />SIONATURE OF APPLICANT: ie' ~ 9r~r'--~---~ ~__~DATE: ~-_._~t~. <br /> <br />MC 15-64 Rev3/g5 <br /> <br /> <br />