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l~oeeived By: ~ <br /> <br />COMPLETI~ ALL SECTIONS, 1 TI-tROUGH 4 <br />1. Job Description <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> ~0 High Street N~ <br /> Salem, OR 97301 <br /> <br /> Code-A-Phe. m~ 588-7904 <br /> F/o: 588.7948 <br /> BUILDING PERMIT APPLICATIOI~AY <br /> ~ARION <br /> BUILDiN~ INSPECTION <br /> <br />Fo. o.,C ON,.Y <br /> <br />2. Location of Installation <br /> <br />C0m~actor Informafi0n . ffq! ~lt.~a.c..,u t/l~ <br /> <br /> I own, ~skle/n. or wfll/resid~ in the completeel stmaure, ! ' <br /> undemland that I must ~g~atcr as a ¢on~tmafion ~omtaetor fi;the stm~tm~ is sold or Offe~l for sale before or utxm exanpletlon. <br /> <br /> will be my own genoral eontracAor. <br /> <br />Lf I h~ subcontractors, I will him only subcontractors mgi~terM with the Constmctlon Cc~tta~tom Boa~. ff I Change my ~nd and do ~c a genem~ contractor, I wiR ~/mct <br />wi~ a c~l~a~r w~ is r~s~ ~ Constm~fi~ C~ B~M, ~d w~ ~a~y n~y Mafi~ C~nty ~ ~ name ~ ~o c~ac~r. <br /> / , n q, ~ :,- ~ ~ ~ d, I , ~ ~-/7// <br /> <br />4. Fee Schedule <br /> <br />' ' B MiSeella~eouz Fees ] <br /> ;:: '(1) Dfiv~¥w/euzb@$7,$0 <br /> <br /> (4) AddMonal Plea Reviews or Add~d~ <br /> <br /> (5) ~v~sfigafi~ F~ <br /> <br /> (6) R~s~ Fee ~ $~,00 <br /> ~) O~r ~c~s not Ested a~ve <br /> <br />TOTAL $ ~7/ fia~F <br /> <br />I hereby cenif~ t~at ~.h¢ above i~orma0.on is m~¢ md ~at I have mad ~d un&rs~nd ~e kfo~/~ Nofi< ~ Pt~eny Ownem about Cmstmefion Raspmsib~ties on ~e <br /> <br /> / / / <br /> <br />MC 15-73 Rev. 11~1 <br /> <br /> <br />