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FOR CJTY VALIDATION <br />Re'cqivedi~Y: ~ <br />Zo~'ing Validation.' <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 HR Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br />City Setback Requirements: <br /> <br />Left S d~: /.~) Right Side:J~ I <br /> <br />FOR CITY USE ONLY <br /> <br />RECEIVEII <br /> <br /> (~NewPlacement Garage ~'~o~ar~o~ I L'~; ! ~ : <br /> ( ) Replacement ( ~At <br /> ( )Additio~UnitAdd-on ( )De~eh~ ~fl~10~ CO~{[~ <br />~e~ Ye~of ~ No. of Len~h .... mn. ,~ ~IIUN <br />N~e: ~1 51~ ~ M~ufact~er q 7 S~tions ~ ~ ' Z? ' <br />~ of Sing: ~e of Roofing: Square FooUge:/~D ~o. of ~ms: <br />( ~ ( ~Comp <br /> <br /> )Vinyl ( )Meal ~0~. <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Mailine~ddmss' 75~ <br /> <br /> Sec~on: ~ Township: ~ Range: ~ ~ ~ne: ~ Map: <br /> ~t Width: ~1 Lot Dep*: / ~ Acres: l~2~yt~upply: Comer: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am the PROPERTY OWNlgR and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I <br /> <br />~h°°e~'l:)?~ .~ b'..~ -/7,* / <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections $245.00 <br />(includes EL, PL, ME connections) <br />Sta~ Sureharg~ $12.25 <br /> <br /> TOTAL <br /> <br />Reinspection Fee $60.00 = ~'~ <br /> <br />I hereby certify that the above in formation 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 />SIGNATURE OF APPLICANT: ~ DATE: Vg4 ~} f7 <br /> <br />MC 15-64 Rev3/95 <br /> <br /> <br />