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FOR. CITY VALIDATION I MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> · .-. ~ ~ [ COMMUNITY DEVELOPMENT cENTER <br /> Rec~l'ved~Bv'_ ~;/n4 · gt~ /~LI ~q,( [/] [ [~' 285 Church St. NE- Room 132 : ty S ~tb~'~gr,.~._~quirements-. <br /> <br /> · , , / ~,~ ,t I Salem, Oregon 97301 <br />]Zoning Vahdauon: , '~fr ! 8:00mn-,l:30pm Phone 588-$147 Front: <br /> <br /> · ~ L-- ! 24 HR lnsl~.~ion Line 588-7904 ' t R ~ '-' t <br /> <br /> MANUFACTURED DWELLING I (1 <br /> COMPLETE ALL SECTIONS, 1 THROUGH 4 · PERMIT APPLICATION tl- "CC, I II I <br /> <br /> (~'NewPlacement Gatagg. or~~') ~FIION COUNty <br /> ( )~placem~t (~c~ BUILDING INSPEC~'ONII <br /> ( ) Addi~onal Unit Add-on ( ) ~mch~ <br /> <br />De~e~ ~LI 9 H~ Ye~ ~ No. of ~ng~ Wid~ <br />Nme: ~ ~ M~uf~r ~ & S~ons 2 ~ & ~ ~ <br />T~ of Siding: ~ of R~fi~: Sq~ Foo~ge: [~ ~ No. of B~moms: ~ <br />( ~ ( ~mp <br />( ) Me~ ( ) S~I ~t Set: Energy: <br /> <br />LotWidth: ~"~'~ Lotl~pth: JO-O I~.Lo,: ICorner: <br />Urban Caowth Boundary? (.~Yes ( )No Wa~rSupply: ( )EcivateWell <br /> <br />( ) Communiiy Well ( .~'~ity <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WItO IS DOING THE WORK <br /> <br />(/f <br /> <br /> ! <br />I am an AUTHORIZED REPRESENTATInfE of th~ property owner or the contractor. <br /> <br />Maillng Address: 2~"~ ~"' Phon~: <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections $245.00 = ~--9--ff-~'- B. Additiomtl Inspeclion/ <br /> (includes EL, PL, ME connections) ~ ~/~-- ~...~ (beyond third inspection) <br /> <br />$60.00 = <br /> <br />I hereby certify that the above information is con'ect. Permits are non-~ansferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br /> <br />NAME OF APPLICANT (pleas '~ _._PHONE: 7b~-77~ay~ <br />$10NATUR~ OF APPLICANT: ._._.._DATE'. ~ff2~//~ <br /> <br />MC 15-64 Rev 3~95 <br /> <br /> <br />