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F~OR CITY VALIDATION MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> <br /> 285 Church St. NE - Room 132 City Setback Requirements: <br />Re~eive~d By: ? d~7/~a~ COMMUNITY DEVELOPMENT CENTER -- -- <br /> <br /> Salem, Oregon 97301 <br />Zoning ~alidafion: ~ 8:00am-4:30pm PhoRe g88-5147 Front: <br /> <br /> FAX $88-7948 <br /> MANUFACTURED DWELLING <br /> COMPLETE ALL SECTIONS, ] THROUGH 4 PERMIT APPLICATION <br /> 1. JOB DESCRIPTION <br /> <br /> ( ) New Placement Garage or Carport <br /> ~N~ Replacement ~Attached MARION GOUNTY <br /> ( ) AdditionalUnit Add-on ( ) Detached BUll_DING INSPECTION <br /> <br />Dealers Year of No, of Length ~, Width <br />Name:¢~f/~f~ ~ Man. fa¢~urer /qq7 Sections c~ qq <br />Type of Siding: Type of Roofing: Sq mu e Foot age: ]kh~:2~" <br /> No. ofBedrooms: ~ <br />( )(~ Wood (~ Comp <br />( ) Vinyl ( ) Metal /tL}~ Energy: -x~Cl~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />O~upant: ~ Mailing Address: ~t OR 97/~/ [ Phone No.: <br />S~tlon: ~0 Township: ~ ~g~: /~ Zo.e: ff~ Map: ~/~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) <br /> <br />aaa the PROPERTY OWNER altd own. reside in, or will reside in the completed structure and wSlI b~ my own general contractor. I un&~rsta~d that 1 <br /> <br /> ( ) I am an AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />$60.00 <br /> <br />I hereby certify that the above information is correct. Peradts are non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 1 $0 days. <br />NAME OF APPLICANT (please print): ,~ .~~ <br /> <br />MC 15-64 Rev3/95 ( 'n~' C ~--( ~ <br /> <br />PHONE: <br /> <br /> <br />