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IDR~CITY YALIDA, TION i <br />ceived By: ~fi7~'~¢-~ <br />ning Validation: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <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 /> RE~£lV£~tlvnT APPLICATION <br /> <br />I FOR CITY USE ONLY <br /> <br /> FCimryntS:etb~k;eq~rements:Rear: j~ ~_ <br /> L~Sid~: 15-2 ~i~htS ~:/fi ~ <br /> <br />Qq- <br /> <br /> ( ) Replacement (t,~Attach~- <br /> ( ) Additional Unit Add-on ~,~0r~] C[}[[~l'f¥ ( )Detached <br /> <br />Dealers~'/~/'l~'J~l~ B !~ [[~Pt~T[O~ No. of Length Wid~ <br />Name: ~ ~ Mmuf~mrer Z/ S~tions ~ 4~ 2 7 <br />Type( ~odSiding: Ty~(~pof ~fing: Squ~ Footage: /~ No. of B~rooms: ~ <br />( ) Metal ( ) Stol Pit Set: Energy: <br />( )Vinyl ( )Metal ~ ~ ~,~. <br /> <br />2. LOCATION OF INSTALLATION <br />,ob I [ <br /> <br />Urban Growth Boundary? ( ~es ( )No <br /> <br />Zone:~ ~ Map: ~.~ <br /> Comer: <br /> <br /> Irt. Lot: <br /> Water Supply: ( ) Private Well ( ) Community Well (~'~ity <br /> <br />3. gtONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( t~ I am an AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections $245.E0 <br /> St~ Sum~e $12.25 <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 />MC 15-64 Rev3195 <br /> <br /> <br />