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~ALIDATION <br />Received By: __ <br /> <br />Zoning Validation: <br /> <br />D~te: _ <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 />FOR CIT____~Y USE~ONLY <br /> <br />*Floor Plan Required* <br /> <br />( ~ New Placement Garage or Carport <br />( ) Replacement ( ) Attached <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers Year of No. of Length Width <br />Name: Manufacturer Sections <br />Type of Siding: 'l~pe of Roofing: Square Footage: No. of Bedrooms: <br />( )Wood ( )Comp <br />( )Metal ( ) Steel Pit Set: Super Good Cents( ) Yes ( )No <br />( ) Vinyl ( ) Metal *Include Documentation <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Occupant: ~ ~ ] Mailing Address: <br /> <br />ICross Street: <br /> <br />Phone No.: ~ 0.,~....,,_.~.._~~ <br />Phone No.: <br /> <br /> Se, cOon: Township: Range: Zone: Map: <br /> Lot Wldth: Lot D~pth: Acres: wants In-_ Lot:apply: Corner: <br /> <br /> Urban Growth Boundary? ( )Yes ( )No ( ) Private Well ( ) Community Well ( )City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br /> ! <br /> Sta~Surchar~ $12.25 = ReinspeclionFee $60.00 = t..l~'~..-/ .~ <br /> <br /> hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started wi <br /> <br />or if work is suspend~l for 180 days. <br /> <br />p.o :qqSd 5scl <br /> <br />MC 15-(:4 Rev 8/96 <br /> <br /> <br />