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]'FOR~ITY VALIDATION <br />~cei~e~t By: ~_~--~ <br />IZonin~ Validation: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEYELOPMENT cElqTEP. <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone $$8-$147 <br /> 24 HR Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br /> I]]: .[I . UrACTUUEO OWELLI C <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 ....... 'PERMIT APPLICATION <br /> <br />FOR CITY USE ONLY <br /> <br /> ( ) Replacement r~nl0~l COUNTY ( ) Attach'~V- <br /> ( ) Additional Unit AddBIdlLDING INSPECTION ( ) Detached <br /> <br />Dealers ~t/-.~/~ L-- Year of No. of Length Width <br />Name: ~J0~4~--~ Manufacturer t ~ 7 Sections <br />Type of Siding: Type f Roofing: <br />( '~'5'~Wood (~Comp Square Footage:./~ No. of B~drooms: ~.~ <br />( ) Vinyl I I)) MetalSteet Er~rgy: <br /> <br />2. LOCATION OF INSTALLATION <br /> ...~:~ ~:~ re.~ ~ Tax Account #: <br /> <br /> Mobile Home park Name: <br /> ~cup~t: Mailing Ad'ess: ~' <br /> <br /> Section: ~ Township: t~.~o Range: 2.. ~{.~ Zone: /~ Map: <br /> Urban Gm~ B~nd~? ( ~ ( ) No Water Supply: ( ) ~vate Well ( ) Co--unity Well <br /> <br />3. CONT~CTOR ~FO~ATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />(/ I am an AUTHORIZED REPRESENTATIVE of tbe property owner or thc contractor. ~ J <br /> <br />4. FEE SCHEDULE <br /> <br />A. Ma~ufa2tur~t Pta~ment/Comt~cdoas <br /> 0nelude~ BL, PL, ME connections) <br /> State Surcharge <br /> <br />$12.25 <br /> <br />$20.00 <br /> <br />(beyond third inspection) <br />Reinspection Fee <br /> <br />$60.00 <br /> <br />I hereby certify that the above information is co.ecl. Permits are non-lransferrable and expire if work is not shafted within I80 days of issuance <br />or if work is suspended for 180 days. <br />NAIvlEOFAPPUCANT(pleasepdnt):~ ~ ~ ~ ~HONE: 7a~--~'9a3 <br /> <br />MC 15-64 Rev3/95 <br /> <br /> <br />