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FOR CITY 'I~ALIDATION <br />· IRdceived Byz <br /> Zonfng Validation: <br /> <br /> }Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> 1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Cburch St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-514'/ <br /> 24 HR Inspection Line 588.7904 <br /> FAX ~88-7948 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br />fLFO .R_,CITY~_U_.S. E' 9NLY <br /> <br /> Setback Requi,,em¢llts: <br /> <br /> Side: Right Side: <br /> <br /> ( ) Replacement ( ) Attached <br /> ( ) Additional Unit Add-on (~,#yDetached <br /> Dea[ers~,~,:t~.C ~}'.S"/'~C. ~ Year of ]~ SectlonsN°'°f ~agth~ Widt~ <br /> Name: I~--V ' Manuf~tumr ~ ~' <br />Type of Siding: Type of Roofing: Squ~e Footage: I$~ No. of Bedrooms: <br />( ~ Wood ( ~Comp <br />:( )Vinyl ( )Metal <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />: JobAddtes*: Tax A¢¢ount. #:I 40,31.0n0 ~/I Oo,,St~t, ~, <br /> <br />Townshlp; <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am an AUTgIORIZIgD P, EpRESENTATPFE of the prOper~y owner or the contractor <br /> <br /> Mail,ag Addm~s; Phone'· <br />4. FEE SCHEDULE <br /> <br /> $7~$,00 = <br /> <br />TOTAL <br /> <br />RECEIPT #: <br /> <br />$60.00 = <br /> <br />I hereby certify that the above informatio~ is correct. Permits are non-transferrable and expire if work is I]ot started within I gO days of isstlance <br />or ff work is suspended for 180 days, <br />NAME OF APPLtCANT Iplease print,: ]"~ ,~ } P. ~U~ PI{ONE: <br /> _ . .... ..... <br /> <br /> <br />