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FOR CITY VALID~TIONI MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY | <br /> City <br /> Setback <br /> <br /> · . . ' ! d'/, I Salem, Oregon 97301 <br />~mng Vali~uon: '"~7 / 8:00am-4:30pm Phone 588.5147 Front= /O,f Rear: t,~ ~ <br />Date: [Ott 3or-- I/~' - l1 24 HR Inspeetion Line588.7904FAX 588-7948 L~fiSide: 1,~ t Right Side: t--~ I <br /> <br /> MANUFACTURED DWELLING <br />COMPLETE ALL SECnONS, ~ THROUOH 4 PERMIT APPLICATION <br /> 1. JOB~ DESCRIPTION ~__ J;:~(~/~ <br /> <br />( ) Replacement (~'y'Attuc~ <br />( ) Additional Unit Add-on ( ) Detached <br />Dealers ~ ~t~fl~/' Year of I No. of Length Width <br />Name: ~}C.~'t,,'L Manufacturer ~7 SecOons a~ /~ b 27 <br />TypeofSiding:( ,eS'~/ood TypeofRoofing:( ~y~omp Square Footage: / 792... No. of Bedrooms; ~? <br />( ) Metal ( ) Ste~l Pit Set: Energy: <br />( ) Vinyl ( ) Metal ~/0 '~.~. ~-. <br /> <br />2. LOCATION OF INSTALLATION <br />U~n G~w~ Bout? (~Yes ( ) No ( ) ~va~ Well ( ) Co~u~ty W~H (~ty <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE ENDICATE V~IO IS DOING THE WORK <br /> <br />I am the PROPERTY OWNER and own, ~ide in, or will reside in the completed structure and will be my own general contractor. I understand that I ] <br />must register as a coflstrucfion!conh'actar if the s~ucto~ is sold or offered for sale before or upon completion. If I him subcontractors, I rail hixo only <br />subcontractors registered with the Construction Contractors Board. If 1 change my mind and do hire a general contractor who is registered with the <br />Construction Contractors Board, I will irmu~ately notify Marion County of the name of the contmccwr. <br /> <br />I am a CONTRACTOR registered with thc State of O~gon. <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufaemnrd Plaecment/Comleetions $2~.5.00 = <br />(includes EL, FL, M~ connections) <br /> <br />B, Additional Inspection/ <br /> (beyond third inspection) <br /> Rethspectio~ Fee <br /> <br />$60.00 <br /> <br />TOTAL <br /> <br />I hereby certify that the above information is corcect. 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 />NAME OF APPLICANT (please pllntJ~~ ~ 0 -/~"~ ~ <br />SIGNATURE OF APPLICANT: ~ <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />