Laserfiche WebLink
'FOR CITY VALIDATION <br />1~, iv~ ~y:' ~~ <br />Zoning Validation: <br />Date: ,_~ -.,~'~ ~ <br /> <br /> MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER Front: f~ <br /> 285 Church St. NE - Room 132 City Setback Requirements: <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 Rear: / ~ <br /> 24 HR Inspeetion Line 588-7904FAX 588.7948 LeftSde: ]~' RightSide:J ~~ <br /> <br /> MANUFACTURED DWELLING <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PERMIT APPLICATION R[[~[IV[~ q ~C) ~ C) q b <br /> 1. JOB DESCRIPTION <br /> <br /> ( ~New Placement Crarage Catpo ~ ! c!'$ ~ ~" ~ <br /> ( ) Replacement (I,,,~.t :, ~ ~ ~ <br /> ( ) Additional Unit Add-on ( ) Detached [~h;~,~i[h~ g~tJ;~lT¥ <br />Dealers/.~f.~ Year of , No. of Length~Oil'l~'''~a .... Width <br />Name: ~.~t,~..~ Manufacturer ¢7 Sections 2. 27 <br />Type of Sidlng: Type~f Roofing: Square Footage: /~0~' No. of Bedrooms: .~ <br />( ~'~ood ( ~'~ Comp <br />( ) Metal ( ) Steel Pit Set: Energy: <br /> <br />2. LOCATION OF INSTALLATION <br /> ./q._~ ~-4~., .2,m-. <br /> <br />MobileHomeParkName: ~.~//~ ~ <br /> <br />ITax Account. #: Cross S ree :~ ~ ~ <br /> <br />Occupant: Mailing Address: <br /> <br />LotWidth: ~' LotDepth: 77' A~: Irt. Lot: Corner: <br /> <br /> ( ) Conununlty Well ( ~'f~ity <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) l am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I <br /> <br />.git3-17 t I <br /> <br />4. FEE SCHEDULE <br /> <br />A. ManufacmredPlacement/Conneedons $245.00 = J'q~,.- B. Additionallnspection/ <br />(includes EL, PL, ME connections) (beyond third inspecfinn) <br />Stat~ Surcharg~ $12.25 = I ~ · ~%~,~" Reinspection Fee $60.00 <br />Stat~ Fee $20.00 = ~, '~ <br /> · · · ). $2o.oo = ~b, <br /> <br />I hereby certify that the above information is correct. Permits are non-lransferrable 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 (please t~ .PHONE: <br /> <br />SIGNATURE OF APPLICANT: .DATE: <br /> <br />MC 15-64 Rev 3195 <br /> <br /> <br />