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06/05/92 14:23 ~503 588 7948 . ~ CELL 1 SYS. DEV. <br /> <br />~001 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High S~e~t NE <br /> · :Salem, OR 97301 , <br /> 8;00~m - 4:30pm Phone $88-5147 <br /> Code-A-~'nor~ 588-7904 <br /> FAX $$8-7948 <br /> <br />FOR OFFICE, USE ONLY <br />City $~l~k Rcquir~nonU; <br /> <br /> BUILDING PERMIT APPLICATION <br />COM~LETIi ALL SECTIONS, 1 TI'I~OUOI'I 4 <br /> <br />L Job Description <br /> <br /> .., . <br />Mo~ Hom~ : , '.' S~ ::.:' <br /> <br />Lct~d~ LotD=~ A~m~ I~g.~t Corner ~mm~b'W~H( ) City ( ),, <br /> <br /> ( ) ~ders~nd~at~mu~tm~s~ra~ac~ns~t~emr~is~e~df~rs~e~re~ru~e~m~e~. <br /> ( ) I w~ be my own g~er~ co~t~ct~ .' . · , <br /> <br /> him sub~ntra~rs. <br /> <br />~ ~ ~nttac/ot who ~ ~ste~d Wi~c C~stmcfi~ C~c~fs ~, an~ w~l ~med~y notify Marion C~nty of ~ name ~ ~e c~ractor. <br />C~aetor Bu~s~ n~c & ~: J M~ Add'ss: ~ P~one: <br /> <br />( ) ! am a ~gglster~ bailder OR th~e,authorizeA.~pm~.t~tive., o~ a ,es stemd <br /> <br /> 4, Fee Schedule , :.. <br />'~. VALUATION (gee "V~luatlafi Schedule"'~ :"' <br /> <br />(I) Dh, v~wuS~ W/curb @ $7.:50 ': : : ~': <br />(2) Driveway w/o curb ~ $17.00 ~ ~ <br /> <br />(1) Permit F~ <br /> <br />(2) $% State Su,e..ham~ (,OS x Al) -~ , <br />O) Stmcturll Plan R~view (.~X Al) =' ' <br />(4) Fim&Lif=Saf~ly~a~R~viow(.~%xA1) ' = ~ <br />(~) ~g Sumha~, if a~Bcable (.05% x Al ) ~ ~ <br /> <br />hereby ccnffy that the above information i* eor~et and'ih~t I have read and unde~cafid ~e Infomri~ Notice m Property Owner~ a~m Construction Responsib~t es ~ ~e <br /> <br /> <br />