Laserfiche WebLink
[FOR CITY VALIDATION J MARION COUNTY BUILDING INSPECTION <br />/ ~/~ t · {9 I COMMUNITY DEVELOPMENT CENTER <br />]Received By: r ~t.,..~V..~..~'~- [ 285 Church St. NE - Room 132 <br />/ 'Pt -.~-- /~' l'/) -D~. Salem, Oregon 97301 <br /> Zoning Validation' ~ Ib~t/4l(~-- ~- ' <br /> : ' --"-z"/--'~l 8:00am-4:30pm Phone $88-5147 <br /> / ' / :4 <br /> ..... FAX 588-7948 <br /> MANUFACTURED DWELLi~i~ {'i~ ~ ~'j~ ~-~ ~' <br /> <br /> L JOB <br /> DESCRIPTION <br /> <br /> ( ~)'"-New Placement Gara~l~ or ~ <br /> ( ) Replacement ( ~ Attached <br /> ( ) Additional Unit Add-on ( ) Detached <br /> <br />Dealers ~:"~-{-~ Year of No. of <br />Name: /-~ r,4 ~'"~ Manufacturer ?~:~ Sections ~ <br /> <br />Type of Siding: <br /> <br /> ) Metal <br /> ) Vinyl <br /> <br />Type~gf Roofing: <br />( ~3 Comp <br />( ) Steel <br />( ) Metal <br /> <br /> FOR CITY USE ONLY <br />~-%fllack Requiremen~ <br /> <br />Square Footage: /~Tp~~No. of Bedrooms~ ..~ <br /> <br /> MARION COUNTY <br />~Width <br /> <br />2. LOCATION OF INSTALLATION ..OOo <br />Job Address: Cro~s Street: <br /> <br />Mobil~ Hom~ Park Name: ~._~_.~/~-'~"'t~ <br />Property Owner: ~ <br />Occupant: <br /> <br />L~ ~idihGr:wt hS:"'u In d ~-~9~. t (D~j <br /> <br /> ?gl. <br /> IL. <br />Mailing Address: ~ Phone No.: <br /> <br /> ~app]y: ( ) Privat~ Wdl ( ) Community Well ( ~t~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />(.~ I am an AUTHORIZED REPRESENTATIVE of the propeay owner or th~ contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manuf~ctu~d Placement/Connections $245.00 <br /> <br /> S~F~ $20.~ <br /> ' · · $20.~ <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reimpeetion Fee <br /> <br />$60.00 = <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 />or if work is suspended for 180 days. <br />NAME OF APPIACANT (pleas~~ . _PHONE: ~ <br /> <br />MC 15-64 P~v3195 <br /> <br /> <br />