Laserfiche WebLink
~F(~R CITY VALIDATIONI MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> ~7 'P'""" t co~umrY oEv~op~r CE~rmR <br /> Received By' ~ ~ ~ 285 Church St. NE - Room 132 City Setback Rcqokcracnts: <br /> .* ' ~ .":+ ~/~ Salem, Oregon97301 [ I <br /> [ZontngVaUdatton: ~t~r. 8:00am-4:30pmPhone588-sln7 I~r°nt: /or I~:ear: /ff ! <br /> ~Date' ~ tg/- ~ 24 HR lnspeefiOnFAX 588-7948Line S88-7904 ~ <br /> MANUFACTURED DWELLIN~_~/~/~.? <br /> coMeu~m ALL Stuccoes, l Th~OUaa 4 PERMIT APPLICATION &~.~ ~/~ <br /> <br /> ()Replacement (w'sf^~ ~l l ~~n~/~/~/ <br /> ( ) Additional Unit Add-on ( ) Detach~ ~/~ ~ <br /> <br /> Type~fSiding: Type%fRoofing: Square Footage: /_~ O ~} [No. of Beclroems: <br /> ( ~Nood ( ~....~eComp __ __ · -- 3f~ <br /> ) Metal ) Steel Pit Set: · I Energy: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Mobile Home Park Name: ~/.~/~ <br /> <br />LotWidth:~'~--/ ~tI~pth: 15~.~/ LAeres: <br /> <br />Urban Growth Boundary? ( .~es ( ) No <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ~ I am an AUTHORIZED REPRESENTATIVE of the propciny owner or th~ contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />(includes EL. PL~ ME connections) <br />State Surcharge <br />State Fee <br /> arge { app ca .c) <br /> <br />$12.25 <br />$20.00 <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not stared within 180 days of issuance <br /> <br />or if work is suspended for i80 days. <br />NAME OF APPLICANT (PkaS~ print): ~ <br />SIGNATURE OF APPLICANT:~ <br />MC 15-64 P,~v 3/95 <br /> <br /> <br />