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I~DR CITY VA~LIDA,T!ON <br /> <br />IZoning ValidatioN" ,e~ <br />[ .Date' J'~///-~'~' <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. JOB DESCRIPTION <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 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 />Left Side: /~0''''! Righi Side: y~.g~ / <br /> <br />¢)~ New Placement ~or Carport <br />( ) Replacement ( ) Attached <br />( ) Additional Unit Add-on (~ Detached <br />NDe2ee~S.~~ Year of No. of Length Width <br /> M u act r/??7 Sec.on, / <br />Type of Siding: Type of Roofing: Square Footage: <br />)Wood sZ7 tset: E.gy: <br />( ) Metal <br />(.~ Vinyl ( )Metal ~--'~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Mobile Home Park Name: ~ Space #: ~ ~ <br />Va~Omw~Sound~? (~es ( )No IWaterSupply: ( )~va~Well ( )Co~uMtyWell (~ty <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> I am the PROPERTY OWNER and own. reside in, or will reside in the completed structure and wig he my own general contractor. I understand that I <br /> must register as a construction conlractor if the structure is sold or offered fo/ sale before or upon completion. If I hire subcontractors, I will him only <br /> subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor who is registered with the <br /> Construction Contractors Board, I will immediately notify Marion County of the name of the contractor, <br /> <br /> / ) <br /> <br />4. FEE SCHEDULE <br /> <br />I mn a CONTRACTOR registered with the State of Oregon. <br /> <br />I am an AUTItORiZED REPRF~ENTATIVE of th~ property owner or thc contractor. <br /> <br />A. Manufactured Placemen0'Conneetions $245.00 = ,~n~~-~ ~ B. Additional Inspection/ <br /> (includes EL, PL, ME connections) (beyond third inspection) <br /> State Surcharg~ $12.25 = ~, ~n~~'' Rethspecfion Fee $60.00 <br /> StateFee $20,00 -- ~r~ ~ <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 />NAMEOFAPPLICANT{pleasepfint): ~'~{~j[_.l~ ~,~, ~[-~ PHONE: ~'~"'-['~{~3 <br />SIGNAq~JRE OF APPLICANT: ~~, ~ ~ ~ DATE: 3~ 1'/--~7 <br /> <br /> <br />