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FOR CITY VALIDAT. ION <br /> <br />Izo~in~ Valida?on: ~ [ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Chareh St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 HR Inspection Line 588.7904 <br /> FAX 588-7948 <br /> <br />MANUFACTURED DWELLING <br />PERMIT APPLICATION <br /> <br /> FOR CITY USE ONLY <br />City Setback Requ~tS[ ' ~ <br />Front: ~10 Rear: ~ <br />L~ftSide: / i lSlde: <br /> <br />1. JOB DESCRIPTION <br /> <br />( ) Additional Unit Add-on ( ) Detached <br />Deale~ tA/t~"t~ Year of , No, of Length <br />· . <br />Name: t.4¢t~ Manufacturer ~7 Sections 2.- ...~--b,I · <br /> <br />Type~0f Siding: ~fpe of Roofing: Square Footage: f~.~ No. of Bedrooms: <br />(.") Wood ( ~fComp <br />( ) Metal ( ) Steel Pit Set: Energy: <br />( )Vinyl ( )Metal ~O <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Section: .~ Township: <br />Lot Width: ~ ~ <br /> <br />ITax Account. #: <br /> <br /> Mailhig Add~ess: <br /> <br />ga,ge: ~ b~ zone: ~_.~/'4 ~P: ~ff.~D~.~ <br /> <br /> Water Supply: ( ) Private Well ( ) Community Well ( ~ity <br /> <br />Space#: <br /> <br /> Pho.e <br /> <br /> Phone No.: <br /> <br />Lot ~: /lb" ' <br /> <br />Urban Growth Bounda~? ( t~es ( ) No <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am thc PROPERTY OWNER and own, reside in, or will r~side in th~ completed structure and will be my own general contractor. I understand that I <br /> mu~t ~egister aa a construction con.actor if th~ sWucture is snid or offered for sale before or upon comptethi~. If I hire subcon~acto~, I will hire only <br /> subcontractors register~l with the Construction Contractor~ Board. If I change my mind and do hire a general con~ractor who is registered with <br /> Construction Co~tractors Board, I will immediately notify Marion County of the name of the ¢onlractor. <br /> <br />[ Mailing Adflms,: <br /> <br />4. FEE SCHEDULE <br /> <br />$245.00 = ,~-~. ~' B. Additional Inspection/ <br /> (beyond third inspection) <br />$12.25 = /~.~4~ Reinsgecfion Fee <br /> <br />$2o.oo =~ t~, 74' <br /> <br />$60.00 <br /> <br />I hereby certify ~ the above information is correct. Permits are non-tnmsfen'able and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br /> <br />NAME OF APPLICANT (plea~ pri~ <br />SIGNATUR~ OF APPLICANT: <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />