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I~OR ~)FFIC~J}~USE~ O/~Ly [, <br />Zoning Validation:'~?.~ [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Stz~et i~ <br />Salem, OR 97301 <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. Job Description <br /> <br />tFOR O]~FICE. USE ONLY <br /> <br />2. Locationoflnstallafion ,, : :-., :.:. <br /> <br />3. Contractor Information ,:. :] ,>, : <br /> <br /> ( ) I under.nd ~at I must'm~s~ a~ a ~st'~'~ ~6's~aum ~ :so~ or ~d f~ s~o ~ otu~n ~pl~. <br /> ( <br /> ) <br /> C ~ ,~, . <br /> <br /> ( ) I am a ~gi~d builder OR ~ au~o~d ~pm~fiw of ~ ~g~ ~d~, <br /> <br /> 4. Fee Schedule <br />I A. VALUATION ($¢, "Valua~:m $~hc. dule" ' <br /> <br /> squar~ foo~,) <br /> <br /> (1) P~h F~ <br /> ~) ~% ~ Su~a~ (-0~ x A I) <br /> (~) St~m~ Plan ~6W (.65~ X A1 ) <br /> (4) Fire & ~fe SMety Plao Review (.~% x Al) <br /> <br />TO'fAf, $ ~0, l? <br /> <br />I hereby ~eaify &at the above laformatiOn is cor~ ~md thai I have ma~ and understand thc Im%rmatie~ N~cc to Prop~ay Own,rs a~ur ConstlmoQon Responsibilllies on thc <br /> <br /> Site evaluations, gepde, ~6ctdcal, plumb~g ~d mcchaRical wo~ mqffi~ ~Ic ~i~, C~ wi~ Mafi~ County B~ld~g Ins~aion ~fo~ gu~itting ~is apphcafion. <br /> <br />MC 15-73 Rev. 11~1 <br /> <br /> <br />