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'FOR CITY VALIDATION] MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />Received By: I] ~ . ~llAtn4~0~~ . - oom 132 City Setback RVxluiroment s: <br /> ~ I Salem, Oregon 97301 <br />Zoning Validation: i _ ~?5_L~_~~ I 8:00am4-30pm Phone 588.5147 Front: <br />DaM. I 24 HR I~pection Line 588.7904 t~ L~ftSide IRiehtSide- <br /> <br /> MANUFACTURED DWELLING I& <br /> <br /> ( ) Replacement (-~ Attached ~ ~ <br /> un. OIN~ ,.. uuNTy <br /> ( ) Additional Unit Add-on ( ) Detached ~ //~S~, <br />Dealers ~ O,~'~2.. tI Year of No. of Length Width ]0[~ <br />Name: ~ n.~.~ Manufacturer ~ )* Sections ~ .~...~ , ~- ~' s <br /> <br /> woSiding: Type of Roofing: Square Footage: /~t~l~ No. of Bedrooms: ..~ <br />od ( ~omp <br />) Metal ( ) Steel Pit Set: Energy: <br />) Vinyl ( ) Metal ~ ~ ~/.~.~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />MobileHomeParkName: ~/A~40~'~ l~",~-~t-I~ <br /> <br />Space#: <br /> <br />IPhone No.: <br /> <br /> MailingAddms~: ~'a7 ~/S~ ~ <br /> <br />3. CONT~CTOR ~FO~TION ~ PLEASE INDICATE W~O IS DOING T~ WORK <br /> <br />(,O''/ I am an AUTHORIZED REPRESENTATIVE of the property owner or the contractor. <br /> I Mailing Address: <br /> <br />4. FEE SCHEDULE <br /> <br />Manufactured Placement/Connections $245.00 = <br />(includes EL, PL, ME connections) <br />State Surcharge $12,25 = <br />State Fee $20.00= <br /> <br />$60.00 = <br /> <br />I hereby certif~ that thc above information is correct. Permits are non-lransfelxable 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: , ~'I'~/~ <br /> <br />MC 15-64 Rev3/95 <br /> <br /> <br />