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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 $88-5147 <br /> 24 HR lnspeotion Line $88-7904 <br /> FAX 588-7948 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br />I FOR CITY USE ONLY <br /> <br /> City S~tba~k RequUements: <br /> <br />~-a side:~ ~g' * <br /> <br />1. JOB DESCRIPTION <br /> <br />( ~"Ne w Placement Garage (Cmpo-~TM ; <br />( ) l~placement ( <br />( ) AddifionM Unit Add-on ( ) De~h~ <br />~alers ~~ Ye~ of t No. of ~ng~ Wid~ <br />N~e: ~ M~uf~m~r ~7 S~fions ~~ D L 7 <br />~ of Si~ng: Ty~ of R~fi~: squ~ ~ootage: ~ No. of B~oms: <br />(~ W~d ( ~Comp <br />( ) MeM ( ) Stol Ht S,t: ~ergy: <br /> <br />2. LOCATION OF INSTALLATION <br />MobiloHomeParkNam¢: {A~$'~-'"~l~ Space#: .~ <br /> <br />Prol~ Owner:. <br /> <br />Occupant: <br />Section: 30 Township: ~ ~'- Rang:: <br />LotWidth: ~1 ~t~: /~ / A~es: <br /> <br />Mailing Ad~ress: <br /> <br />Phone No.: <br /> <br /> Irt. Lot: <br /> Urban Caov.~h Boundary7 (.e~ez ( ) No Water Supply: ( ) Private Well ( ) Community Well (~ City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE V~-IO IS DOING THE WORK <br /> <br />( ) I am the PROP~J{TY OWIqER and own, reside in, or will reside in tho completed structure and will be my own general e~mtractor. I understand that I <br /> <br />4. FEE SCHEDULE <br /> <br />B. Adthtionallnapccfion/ <br /> Coeyondthkdinsgection) <br /> Rethspexfion 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 stmed within 180 days of isstmnce <br />or if work is suspended for 180 days. <br /> <br />MC 15~o4 Rev 3/95 <br /> <br /> <br />