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FOR CITY VALIDATION <br />Received By: __ . ] <br />Zoning Validation: <br />Date: <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 152 <br /> Salem, Oregon 97301 <br /> 8:00~m-4:30pm Phone 588-$147 <br /> 24 HR Inspection Line 588-7904 <br /> FAX $8~-7948 <br /> <br /> MANUFACTURED DWELLING <br /> PERMIT APPLICATION <br /> <br /> FO____~R CiTY USE ONLY <br />City Setback Requirements: <br /> <br />( )~w Placement Garage or Carport <br />(~) Replacement ( ) Attached A]]~]. <br />( ) ~tion~ UMt Add-on ( ) ~ch~ <br />) W~ ( ~Comp <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Mobil~ ltome Park Name: <br /> <br />Mailing Address: <br />Mailing Address: ~- Phon~ No.: ( <br />Zone: / M~p: <br /> Water Supply: ( ~ate Well <br /> <br /> Lot Width: <br /> Urban Growth Boundary7 ( ) Y~s ( Ko ( ) Community Well ( ) Cit~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) [ am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I] <br /> must mglst~r as a .co~tmcfi~n contractor if ~he structure is sold or offered for sale before or upon complctlon. If I hffe subcontractors, I 'Mil him only] <br /> subcontractors registered w~th the Construction Contractors Boa~. If I change my mind and do him a g~rmral contractor who is registered with thc <br /> <br /> (l~ I am a CONTRACTOR r~glstcr~d vfith tbe State of Oregon. ] <br /> Mailing Address: Phone: <br /> <br />4. FEE SCHEDULE <br /> <br />(includes EL, PL, M~ connections) <br /> <br />$llg$.oo=~~"''d'-- B. AddifionaiInspecfion/ <br />  Co~yond third inspection) <br />$12.25 = Reir~pecfion Fee <br />$20.00 = <br />$20.~ = <br /> <br />$60.00 = <br /> <br />I hereby c,~fy that the abov, information is correct. Permits are non4ransfcrra~ if/~'~no~t ~ within 180 days of ,suance <br /> <br />MC 1544 R~v 3/95 <br /> <br /> <br />