Laserfiche WebLink
Zoning Validation: ~ 1 <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <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 I <br />~toYn tS: e t h acl ;ui7 ea'~ :Re ar: ~0/ <br />Left$ide: /0/ R~ghtSide: ~p' <br /> <br />04-21-97 A09:56 <br /> <br />1. JOB DESCRIPTION <br /> <br />( ,,4'l~ew Placement Garage oo~a~-'~rt <br />( ) Replacement (,.~Atta~ <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers ~t ~ Year of t No. of Length t Width <br />Name: h~a,4~m~.'~ Manufacturer ¢"7 Sections ~.. ~1[ ~ ,i~ <br /> <br />Type of Siding: Type of Roofing: , Square Footage: //~,.~'-t1 No. of Bedrooms: ~,~ <br />( .,'~Vood ( .,'~Comp <br />( ) Metal ( ) Steel Pit Set: Energy: <br />( )Vinyl ( )Metal ~;} ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> MobileHomeP~kN~:~/~~ ~ ~ I Spaceg: ~ ~ <br /> P~p~ Owner'~ <br /> <br /> ~eupant: I Maning A~ess: I PhoneNo.: <br /> <br />Seo~on: _40 2 t/O Map: <br />Lot Width: ~-.--~- Comer: <br /> <br />Township: aOX ~ge: Zo.e: <br /> <br />Lot Depth: Acres: Irt. Lot: <br /> Water Supp y: ( <br /> <br /> Urban Growth Boundary? ( ,.--~Yes ( ) No ) Private Welt ( ) Community Well ( ~Y~ity <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) I am the PROPERTY OWNER and own, renide in, or will reside in the completed structure and will be my own general contractor. I understand that I <br /> must register as a construction contracto~ if the stracture is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire only <br /> subcontractors registered with the Constraction Contractors Board. If I change my mind and do him a general contractor who is registered with the <br /> Construction Contractors Board, I will immediately notify Marion Counly of the name of the contractor. <br />(.~ I am a CONTRACTOR registhred with the State o f Oregon. <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections $245.00 <br />(includes EL, PL, ME connections) <br />Sta~ Surcharge $12.25 <br />Stat~ Fee $20.00 <br /> <br /> TOTAL <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reinsp~cfion Fee <br /> <br />S60.O0 : <br /> <br />I hereby certify that the above information is correct. Permits are non4ransferrable 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 print): ~ ~ ~ ~"~ PHONE: 7~'q--/ <br />SIGNATURE OF APPLICANT: ~~'~~)4~'~ ) DATE: <br /> <br />MC 15-64 Rev3/95 <br /> <br /> <br />