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I FOR CITy. VALIDATION <br />Re~qived ~ Q~ <br />Zoning ~cJat~on:'~.~ <br />Date: [ ~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNIT~ DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00mn-4:30pm Phone 588-5147 <br /> 24 HR Inspection Line 588-7904 ~l'~ ~ ~'~ <br /> <br /> MANUFACTURED DWELLII~ ~ -- <br /> PERMIT APPLICATION ~t& <br /> <br />FOR CITY USE ONLY <br /> <br />2iiy Setback Requirements: <br /> <br />2 f997 <br /> <br />1. JOB DESCRIPTION <br /> <br />T:5.~ New Placement Garage or Carport [viARiON COUNI¥ <br />(~Replacement ( )A~ached Wi~J~I~G INSPECTION <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers ~-*P--l'~4Pe.[a/l~ Year of / ¢q7 ScctionsN°' of q.Le,gth ! Width <br /> <br />Type of Siding: Type of Roofing: Square Footage: ~ /~Y g No. of Bedrooms: o~ <br />(t~') Wood ( ~5 Comp <br />( ) Metal ( ) Steel Pit Set: Energy: <br />( )Vinyl ( )Metal <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />/ob Address: ~ <br /> <br /> Mobile Home Park Name: M0~- <br /> <br /> O~upaat: I ~ding Address: <br /> <br />No <br /> <br /> Acres: ~ - <br /> Urban Growth Boundary? ( ) Y~ ( ) No I Water Supply~te Well O C?mmunity Well <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> (~r i am the PROPERTY OWNER and own, reside in, or will reside in the completed stmctur* and will be my own general conwactor. I understand ~hat 1 <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections $245.00 = ~ <br />(thcludes EL, PL, ME connections) ,~ ~ <br /> State Sureberge $12.25 = <br /> I.;/ <br /> State Fee $20.00 = <br /> Zoning Sttrc barge (if applicable) $20.00 = <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reinspecfion Fee <br /> <br />$60.00 = <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within t80 days of issuance <br />or if work is suspended for 180 da . - <br /> <br />NAME OF APPLICANT (please print ~ I Ox~A ]~",PHONE: ' 0f <br /> <br />SIGNAq[IJRE OF APPLICANT: -- _ ff~_ - - ATE: <br />MC 15-64 Rev3/95 <br /> <br /> <br />