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FQR CIT,Y VALIDATION <br /> <br />Zoniag~ Validation: <br />Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> L 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 />FOuR CIT~Y USE ONLY <br /> <br /> ?r-' I ghiSlde:/a <br /> <br /> (~ewPlacement Garaeor arp~ l'~i".~ t' <br /> ( )Replacement ( ~2t~che~~ <br /> ( ) Addifion~ Unit Add-on ( ) Demch~ [~A,,,~ <br /> <br />Type of Siding: Ty~ of Roofing: Sq~ Footage: ~ ~ ~ O No. of Bedrooms: <br />( ~Wood (~C Drop <br />) Metal ( ) Steel ~t Set: Energy: <br />) Vinyl ( ) Metal ~ 0 <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Property Owner: ti ' . j I Mailing Address' It ~ C'~~'~'~ ~' '~ ~ I Phone No' <br /> <br /> O~up~t: ~ I Mailing Address: Pho~ No.: <br /> <br /> U~ Gm~h Bo~d~7 ( ~es ( ) No ( ) Pfiv~e Well ( ) Community Well (~i~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) I am thc PROPERTY OWNER and own, reside in, or will reside in tM completed stxuctur¢ and will be my own general contractor, l undersland that I <br /> must register as a construction contractor if the structure is sold or offered for sale before or upon completion, ff I him subcontractors, I will hire only <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manu factored PLac~aent/Connecfions <br /> (includes EL, PL, ME connections) <br /> <br />$2d5.00 = 2 q~',--- B. Additional Inspection/ <br /> (beyond tbad inspection) <br />$12.25 = 1~.'~.~' RelnspecfionFee $60.00 <br /> <br />$2o.o0 = <br /> <br />I hereby certify that the above inforraation 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 />NAME OF APPLICANT (pleas¢~ .PHONE: <br /> <br /> <br />