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~OR CITY VALmAT~ON <br />Received By: __ ] <br />Zon~g Validation: <br /> <br />Date: <br /> <br /> CO/VIPLETE AI~. SECTIONS, 1 THROUGH <br /> <br /> 1. ~OB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem. Oregon 97301 <br /> 8:OOnm-4:3Opm Phone 588-5147 <br /> 24 HR InspecUon Ltne 588.7904 <br /> FAX 588-7945 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br />FOR CITY USE ONLY I <br /> <br />( ) New Placement Garage or Carport <br />lplacment ()Attached <br />itional Unit Add.on ( ) Detachol <br />Name: Manuthcturex Sections <br />Typ~ of Siding: Typ~ of Roofing: <br /> b ..3 <br /> ( ) Steel Fit Set: <br />()Vinyl ( )Meal ~\ ~'~'~ C <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Mobile Home Park Name: <br />Property <br /> <br />Se~ion: Township: <br /> <br />"lb--IlO-l: <br /> Spac~ #: <br /> <br /> U~banCnowthBoundary? ( )Yes J~No WaterSupply: ,,~ivateWell <br /> ) Community Well <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WltO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />I he.by ce~ify tha~ thc above information is corm~L Permits m'e non-~ansferrablc and expire if work is not s~ted within 180 days of issuance <br />N°r~)~FZC~ANTnd~PIfi~P~O~dnt~Ts' l~'~ I'"~'~'~ '~ ~ .~t/l~-S~V~, PI-iON,: ~ 76 c~-7~ <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />