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I'OR OTY VALIDATION] MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> Received'By: ~ COM 2Msl~hlTuYrc~ESt~q~O_P~V~EooN~m iC3E2NTER ~ Ici,Setback Requirements: <br /> Zoning X;alidation: <br />Date' <br />I' -- I FAX 588-7948 <br /> <br /> MANUFACTURED DWELLING <br />COMPLETE~d~LSECrlONS IIIIROUOH4 PERMIT APPLICATION .. <br /> <br /> 1. JOB DESCRIPTION <br /> <br /> ( )Replacement (',"DAttachetU ("'~/0/~/'' <br /> ( ) Additional Unit Add-on ( ) Detached <br /> <br />Dealers .g~/~r/~ ~ Year of * No. of Length Width <br />Name: l~ ~-4 ~' Manufacturer ~'~ Sections ~ ~ <br />Type~q.~ Siding: Type of Roofing: Square Footage: ~,~ No. of Bedrooms: <br />( .~ Wood ( ~'~omp <br />) Metal ( ) Steel Pit Set: Energy: <br />)Vinyl ( )Metal ~) <br /> <br />se~ao~: ~ To~.sblp: ,r.~ S=se: ,,~ ~ Zo.e: /g~ ~aO: ~ <br />Lot Width: ~ Lot Depth: / ~ Acres: Irt, Lot: Comer: <br /> <br />Urban Growth Boundary? (~j'~es ( ) No Water Supply: ( ) Private Well ( ) Commtmity Well <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />[ am the PROPERTY OWNER and own, ~sid~ in, or will reside in the completed structure and will be my own general contractor. I understand that [ <br />must register as a construction contractor if the structure is sold or offered for sale before or upon completion, If I hire subconh'actors, I will hire only <br />subcontractors registered with the Const~mctlon Contractors Board. If I change my mind and do hire a general contractor who is registered with the <br />Construction Contractors Board, I will immeatstely notify Marion County of the name of the contractor. <br /> <br />1 am a CONTRACTOR registered with the State of Oregon. <br /> <br />Phone: <br /> <br />4. FEE SCHEDULE <br /> <br />P, ECmPT #: OC'~ <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reinsgection 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 /> <br /> print; ~ ~:~ PHONE: <br />NAME OF APPLICANT (please ~ <br />SIGNATURE OF APPLICANT: DATE: ~9.. . <br /> <br />MC 15-64 Rev3t95 <br /> <br /> <br />