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]~OR CITY VALIDATIONI <br />Reeeived By: __ <br />Zoning Validation: I <br />Date: ] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 58g-5147 <br /> 24 HR Inspection Line 588.7904 <br /> FAX 588.7948 <br /> <br /> ~ MANUFACTURED DWELLING <br /> <br />COMPLE~EALLsEcrIo~S, ITm~OUa~t,: PERMIT APPLICATION hR -, ~ / --~ <br /> 1. JOB DESCRIPTION ~0. ~D. ~.~V~.~:.~. <br /> <br />( ) New Placement Garage or Carport <br />~) Replacement ( ) Attached <br />( ) Additional Unit Add-on ( ~ Detached <br />Dealers Year of No. of Length <br />sine: M~nnf~r Sectious <br />Type of Siding: Type of Roofing: Square Footage: No. of Bedrooms: <br />( ' ) Wood (~) Como <br />( ) M~al ( ) Ste~l Pit Set: Energy: <br />( )Xrmyl ( )Metal <br /> <br />2. LOCATION OF ~STALLATION <br /> <br />Lot Width: '~ ~} Lot D~pdi: {~ ~ Acres: <br /> <br />Mail ng Address: Phoae No.: <br /> <br />Urban Growth Boundary? ( ) Yes ( ) No Wa~r Supply: ( ) Private Well ~ Community Well ( ) City <br /> <br /> CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />~.FEE SCHEDULE <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reinspeetion F~ <br /> <br />$60.00 = <br /> <br />TOTAL <br /> <br />I boreby certify that tbo above information is con'e~t. Permits are non-transferrable and expLre if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br />N~ OF APPLICANT (pl,ase print): ~'-A. ~.~, ~ ~0ST~'' PHONE: ~t ] q ~ ~ <br /> <br />MC 15-64 R~v aDS <br /> <br /> <br />