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FOR CITY VALIDATION <br />Received By: __ <br /> <br />Zoning Validafion: <br /> <br />Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. JOB DESCRII~ION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am4:30pm Phone 588-$147 <br /> 24 ItR Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br />IFO__~ CIT~Y USE_~___ONLY <br /> <br />( ~J New Placement Garage or Carport <br />( ) Replacement ( ) Attached <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers Year of Iq~'O ND. of Length ~9~1 Width <br />Name: Manufacturer Sections <br /> <br />TyI~ of Sidhlg: ~l~pe of Roofing: Square Footage: t0~4 No. of Bedrooms: <br />( )Wood ( )Comp <br />(~) Metal ( ) Steel Pit Set: Energy: <br />( )Vinyl ( )QMetal ~__~k~--~ C~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Space #: <br /> <br /> ~ [lm Lot: Cmer: <br />~t Wide: ]~ ~t Depm: 1Acres:' <br />U~ G~ Boun~ ( ) Yes ( ) ~o Water Supply: ( ) ~va~ Well ( ) Co~nity Well ( ) City <br /> <br />3. CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) I am the PROPERTY OWNER and own, reside in, or will resido in tho completed shnieture and will be my own general contractor. I understand that I <br /> must rogister as a construction contractor if the stmctur~ is sold or offered for sale before or upon completion. If I hit* subconh-actors, I will him only <br /> <br />4. FEE SCHEDULE <br /> <br />B. Additional Inspection/ <br /> (beyond thitat [aspect[an) <br /> Rein spectlon Fee <br /> <br />TOTAL <br /> <br />I hereby c~rfify that the above information is correct, Permits are non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspend~i for 180 days. <br />NAME OF APPLICANT (pIease print): 3~"~ ~-~h } /"~O.~ PHONE: 6 '~&0--S~t/'~ <br /> ~l~ ~ ~ DATE:. <br /> <br />MC 15-64 Rev3~95 <br /> <br /> <br />