Laserfiche WebLink
FOR CITY ~ALIDATION MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY I <br />R;c~'ived B;: ~ COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 City Sethack Requirements: <br /> Salem, Oregon 97301 <br />ZoningValidatio.n: ~.l./~b.-'" 8:00am-4:~0pmPhoneSgg-5147 ~ Front: { 0/ Rear: <br /> 24 HR lnspection Liae 588-7904 lSJt//.~ ~/~'~ *.-._ LeftSide: [.~! RigbtSide: <br /> MANUFACTURED DWEL~..~ '~, <br /> COMPLETE ALL SECTIONS., zm~ouoa 4 PERMIT APPLICATION S~'.p <br /> <br /> 1. ,lOB DESCRIPTION <br /> <br /> ( ) New Placement Garage or Carport <br /> (~OReplacement ( )Attached ' ~ ~J ]]~ r~,, , i '~._ [ <br /> ( ) Additional Unit Add-on ( ) Detached I~'b <br />Dealers~'~'~ Year of /~ No. of ~ Lengt~.~ Width <br /> <br />'DYPe(~:~ Wood°f Siding: ~i~pe(~%.5 Comp°f Roofing: Square Footage: ~'~ No. of Bedrooms: <br />) Metal ( ) Steel Pit Set: Energy: <br />) Vinyl ( ) Metal <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> ~t Width:igC.30 Lot Dep*~ Acres: [m ~t: Comer: <br /> <br /> g~nOo~Boun~? (~S ( )No WaterSu~ly: ( )~vateWo]l ( )Comu~tyWell ~City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) I am thc PROPERTY OSVNIgR and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I <br /> <br />I am a CONTRACTOR registered wLlh the State of Oregon. <br /> <br />lam an AUTHORIZED RgPRESENTATIVE of the property owner f~ee c(o~n~aafor. <br />~g Address: <br /> <br />RegSstration No.: <br /> <br /> () <br /> <br />4. FEE SCHEDULE <br /> <br />TOTAL <br /> <br />smoo= <br />st2.= = 12..Z-~' <br /> <br />$20.0O <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Ralnspection Fee <br /> <br />$60.00 = <br /> <br />I hereby certify 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 />NAIVI~ OF APPLICANT (ple~e print,: ~ ~0~_ <br /> <br />MC 15-64 Rev3/95 ~ <br /> <br /> <br />