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I~).R C.~TY VALIDATION] <br />Received By: __ I <br />IZoaing <br />Validation: I <br />lDa : I <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <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 373-4427 <br /> FAX 588-7948 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br />City Setback Requirements: <br /> <br />Front: Rear: <br /> <br />FOR CITY USE ONLY <br /> <br />*Floor Plan Required* <br /> <br />( g'"~New Placement Garage or Cat'pon <br />( ) Replacement ( ) Attached <br />( ) Additional Unit Add-on ( ) Detached <br />Name:Dealersif~.~ ~ ~,~ /~q ~ Length <br />Z__~,~/~/~' Yearan Ofaeturer No. of Width <br />~.~' Sections ~ g 7 ~'- g <br />Type( ) Wood°f Siding: (Type~comp f Roofing: Square Footage: / ff ~ ~ No. of Bedrooms: ~ <br />( ) Metal ( ) Steel Pit Set: Super Good Cents ( ) Yes ( ) No <br />( )~Vinyl ~ (~ ) Metal <br />s,.~ C~.~)r~at ~ /4/ff,~6- ~ *Include Doctmaentation <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. C.~ITRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> I am the PROPERTY OWNER and own, reside in, or will reside in the completed struci~re and will be my own general contractor. I understand that I <br /> must register ~s a consgruction contxactor if the structure is sold or offered tbr sale before or upon completion. If I hire subcontractors, I will hire only <br /> subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor who is mglstered with the <br /> Construct[on Contractors Board, I wi0 immediately notify Marion County of the name of the contractor. <br /> <br /> ) I am a CONTRACTOR registered with the State of Oregon. <br /> / Business Name: Registration No.: <br /> Mailing Address: Phone: <br /> <br /> I am an AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br /> <br /> Name: <br /> <br /> Mailing Add.ss: Phone: <br /> <br />~l. FEE SCHEDULE <br /> <br />A. Manufactured PlacemenldConnections $245,00 <br />0ncludes EL, PL, ME connections) <br />State Surcharge $12.25 <br />Stale Fee $20.00 <br />Zodng Sumh~rge (if applicable) $20.00 <br /> <br /> TOTAL <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reinspec0on Fee <br /> <br />$60.00 <br /> <br />or if work is suspended for 180 days. <br /> <br />NAMEOF.PL,CANT(pIcaseprint): <br />SIGNA~E OFAPPLICANT: ~ <br /> <br />l hereby certify that the above information is correc Permits am non~transferrable and expire if work is not stmted within 180 days of issuance <br /> <br /> <br />