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~F~I~'£ITY VALIDATION [ MARION COUNTY BUILDING INSPECTION <br />I xy ,n ~,~ z ~ fl COMMUN~Y DEVELOPMENT CENTER <br />lReceivedBy: q.,q~og~t'r~.~4{(e._ 285 Chutch St. NE - Room132 SetbackRequi~ments: <br />/z . . . t.~ b ~4'tt I Salem, Oregon97301 <br />! orang Valid~i/'on: [ ~ ] 8:00am-4:30pm Phone $88'5147 <br />|Date: //.~o/'F '7 / 24 HR Inspection Lire S88-7904 <br />/ -- ' / FAX 588-7948 <br /> MANUFACTURED DWELLING <br /> COMPLETE ALL sec.no~qs, t TtmOUa}t n PERMIT APPLICATION <br /> I. JOBD SC mON CFlrDq3'S <br /> <br />FOR CITY USE ONLY <br /> <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers ~,~i~J~. Year of , No. of L~ngth '4 <br />N~: ~'J ~anura~tur~r q 7 S~tions ~ <br />( ) Me~ ( ) Stol Pit Set: E~r~: <br /> <br />RiSht Sld~: I 0 / <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> UrbanOmwthBo~ndarf (~es ( )No W~Supply: ( )~vateW~ll ( )Co~we~ (~ <br /> <br />3. CON~CTOR INFO~ON ~ PLEASE ~DICATE ~0 IS DOING ~ WO~ <br /> <br /> m~t ~$s~r ~ a ~c~ ~ if ~e s~ is sold ~ o~ for ~ ~ or u~n cool.on. If I M~ su~on~tom, ! .gi~ ~ <[y <br /> <br />4. FEE SCHEDULE <br /> <br />$245.00 = ~ ~l's~g""~B. Ad~itionallnspeaiont <br /> ~ (beyond third insl~ctioa) <br />$12.25 = 's~['~l~'' ~'~ ReinspecfienFee <br /> <br />$~o.0o = <br /> <br />I l,greby certi~ that the above information is correct. Permits ar~ non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. t <br />~AM~ O~ A~c^~r ~,~,.~ ~~ .~HO~: 7ff~ ,~ - 7~ gt~ <br />SIONATUILE OF APPLICANT: DATE ~ 7 <br /> <br /> <br />