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FOR CITY VALIDATION <br />l~eceived By: <br />Zoning Va!idation: <br /> <br />Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br />COMMUNITY285 ChurchDEVELOPMENTst. NE - Room CENTER132 Iicity Setback Requirements: <br /> 8'00am- · e ~ ~ ~ <br /> · I ftSide <br /> 24 HR . 4 <br /> <br /> MANUFA C~;.~I~R~g gV~E~I~, ~ <br /> PERMIt AP~E~A~bS~'~ <br /> MARION COUNTY <br /> BUILBIN6 ~NSPEGT~ON <br /> <br />(~ New Placement Garage or Carport <br />( ) Replacement (~Attached ~tb4~.,[::~O~..~ <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers Year of No. of Length I Width <br />Name: ~[..~t~;~l::>,~,n~ Manufacturer t~0:~ Sections % 4~tI Z~'~'° <br />Type of Siding: Type of Roofing: Square Footage: t "~d7 5 No. of Bedrooms: ~ <br />0a~ Wood ~) Comp <br />( ) Metal ( ) Steel Pit Set: Energy: <br />( )Vinyl ( )Metal <br /> <br />2. LOCATION OF INSTALLATION ,~c~-nSag//-e ~r~ 9' 7.¢.2/- <br /> <br />'°b Address: ~/~''[ %'~r'nl~__-- '["% ~"~ ~t'Tax Acc°unt' #: ~/..jt~ ~'7'~,/ Cr°ss Street: <br />- ~- ~ ~ Space g: <br />Mobile Home P~k Name: ~j~ ~. ~.~ ~ ~~~ ~ ~ <br />Prope~y Owner: K~ ~*~ ~ ~g~ Mailing Address: <br />Occupant: Mailing Address: Phone No.: <br /> <br />Section: ~ O Township: ~S Range: ~ ~ Zone: ~M Map: <br /> <br />Urban Growth Bounda~? ( ) Yes ( ) No Water Supply: ( ) Private Well ( ) Community Well ~ity <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I <br />must register as a construction contractor if the structure is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire only <br />subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor who is registered with the <br />Construction Contractors Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />I am a CONTRACTOR registered with the State of Oregon. <br /> <br />[ Business Name: ~.,~ ~__~lr~Ts Registration No.: <br /> <br /> Mailing Address: _~.~.~ y~r~[~. ~.~ ~~~one: ~O~ <br /> <br />I am an AUTHORIZED REPRESENTATIVE of the pro~y owner or the contractor. <br /> <br />Name: <br /> <br /> Phone: <br /> <br />4. FEE SCHEDULE <br /> <br />m. Manufactured Placement/Connections $245.00 = 15;~¢'~ ~ a. Additional Inspection] <br /> (includes EL, PL, ME connections) ~ ~ (beyond third inspection) <br /> State Surcharge $12.25= /_~.. ,o~--~ Reinspection Fee <br /> State Fee $20.~ = ' <br /> ~ning Surchgge (if applicable) ~ ~. ~ <br /> ~.-1 <br /> TOTAL ~Z ~ <br /> <br />$60.00 = <br /> <br />hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance <br /> <br />or if work is suspended for 180 days. <br /> <br />NAME OF APPLICANT (please print): <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />MC 15-64 Rev 3/95 <br /> <br />DATE: ~-- i O- cl Co <br /> <br /> <br />