Laserfiche WebLink
FOR CITY VALIDATION I <br />Received By: ~ <br />Zoning Validation: ' v,~V- I <br />Date: otg-tg~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00aln-4:30pm Phone 588-5147 <br /> 24 HR Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requirements: <br /> <br />COMPLETE ALL1. JoB~SECTIONS' 1TI-IROUCH 4DESCRiPTiON q ~O- PERMIT6~ Z [APPLICATION. <br /> <br /> ( ~New Placement Garage Carpo · <br /> ( )Replacement ( ~AttacCa~ ~--t~'~il~l~l~':*"~'~lJ~l}~lt <br /> ( ) Additional Unit Add-on ( ) Detached I~ll~'- <br />~em ~l 9~ Ye~ of No. of ~ng~ Wid~ <br />Nme: ~ M~ufact~r ~7 Sections ~ ~b t ~7 I <br /> <br />'~d T~e of R~fing: Square Foo~ge:/~ ~ No. of B~ms: ~ <br /> ( ~mp <br />( ) Metal ( ) Stol Pit Set: Energy: <br />( )Vinyl ( )Meal ~ ~, <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Mobile Home Park N~ne: ~,.~)/..~1~ ~e.~n., /~tt~_,.~ ~,.~p Space #: 2.. ~' ' <br />Property Owner: ~/ll4 g~.~ Mailing A.d~ess'/'~ ~ ~"~- <br />Occupant: Mailing Address: Phone No.: <br /> <br />Lo, Width: _4'5'' <br />Urban Growth Boundary? ~ Yes (.~) No Water Supply: ( ) Private Well <br /> <br />( ) Community Well <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <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 hh-e subcontractom I 'Mil hire only <br />subcontractors registered with the Construction Contractors Board. If 1 change my mind and do hire a general contractor who is ~egistered with the <br />Construction Contractors Board, I will immediately notify Marion County of the name of the contrac~r. <br /> <br />I am a CONTRACTOR registered with the State of Oregon. <br /> <br />I am an AUTHORI~D REPRESENTATIVE of the property owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Plac~m~nffConne¢fions $245.00 <br /> (includes EL, PL, ME connections) <br /> <br /> Stat~ Fee $20.130 <br /> TOTAL <br /> <br />B. Addltiona[ Inspection/ <br /> (beyond third inspection) <br /> Reinspeefion 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 t80 days of issuance <br />or if work is suspended for 180 days,, /"~ <br />NAME OF APPLICANT (please printP ~_~, ~j~.~ ~__~ ~ ~O PHONE: <br />SIGNATURE OF APPLICANT:~ DATE: <br /> <br />MC 15~04 Rev3~95 <br /> <br /> <br />