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FOR CITY VALIDATION] <br />Rec~vedBy: <br />Zonihg Validation: L_. <br />Date: ~ -a-~-~_ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> P <br /> lacement <br /> acement <br /> <br />( ) Additional Unit Add-on <br /> <br />Type of Siding: <br />(~) Wood <br /> ) Metal <br /> ) Vinyl <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Job Address: <br /> <br />Mobile Home Pm-k Name: <br /> <br />Section: ~-0 Township: <br /> <br />Urban Growth Boundary? ( )Yes ( )No <br /> <br /> FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 City Setback Requirements: <br /> Salem, Oregon 97301 <br /> 8:00am.4t30pm Phone 588-5147 F~ont: <br /> 24 HR Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br /> Garage o A R~K~ffff C 0 tJ NTT <br /> ~ BUILDING INSPECTION <br /> ( ) Detached <br /> <br />Year of I No. of [ Length Width <br />~'l;ru~cturer ~ 4 Sections ~L 5~i 2"11 <br />Type of Roofing: ~edrooms: <br />( ) <br />( )Metal PitSet: <br /> <br /> Cross Street: <br /> <br /> ~ ( ) Private Well ( ) Community Well ~i~City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br />() <br /> <br />I am an AUTHORIZED REPRESENTATIVE of the properly owner or the conltactor. <br /> <br />~ho~__-iltq 77¢~ <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections <br /> (includes EL, PL, ME connections) <br /> State Surcharge <br /> State Fee <br /> <br /> TOTAL <br /> <br />*moo = ,,.o¢~ ~ <br />s,2.2s = ~..<- <br />$20,00 = ~. /J~-) <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Relnspeefion Fee <br /> <br />I 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 /> PHONE: ~ <br /> DATE:~[~ L~L~ <br /> <br /> <br />