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MARION COUNTY BUILDING INSPECTION <br />' FOI~ OFFIC~E USE ONLYI 220 High Stxeet NE ~ [~O.I~OFFICE USE ONLY~ <br /> Receivedby;~ . $~em, OR973~ ~ ~ ~ ~ ~[~y~'~'R~q~mts: / <br /> ZonlngValidatio I 8;~-4:3~~7~ ~ ~ H ~l~t4[~ ~==: r I <br /> <br /> 1. Job~dption ~ ,JUL ~ B W~ MARION COUN1Y <br /> <br />2. Location of Installation i :,. ~m'~, g --: ~e/¢/,0F~.- q77~0 <br /> <br /> 3. Conm~ctor information i ' <br /> <br /> ;( * · )~ unversed ~at ,I'mmt, ~s~r as a c~!mcfi~'c~t~r ff ~e s~:~ $oM or ~e~ f~ sale'b~fom Oru~ <br />'1( ) I ~ ~ my,o~ gm~ c~tm~, ,' : <br /> <br /> ~ ~ chmge my ~d ~ do Nm a g~ ~o~r, I~ ~t ~ a cm~or who is ~ste~ wi~ th= Cons~c~on ContractoCs Boor~, and <br /> <br /> :C~c~r Bus~ss Name & 8, 0 ' ' ] M~ Add~ss ' <br /> <br /> ,~: . : :.; ; :::, <br /> or~mUmtmacmmUC~o~ ~ $182.00=~ C Addi~sp~ ~ $60.~= <br /> <br />L <br /> <br />@ $ 25,00 =.__ <br /> <br />E, Other thstmctlons not hstad <br /> @ 40,00 I~t holi~ C2 hear minimum) <br /> <br />@ $40.00 <br /> <br />I hereby certify that thc above ixfformafion is correct and that I ha~e re:id and unS~rstand the Information Nofce to Property Owners about Construct[on Responsibilities <br /> <br />l~ds fee c~ers ~c manuhcta~d structure p a~mcot, p umb~g m~ccum, ~ectfic~ c~ccn~ ~ggechanica comcct on. $ te'eva uafi~~ ~ soptie pe~%ctfical <br /> <br /> MC 15-64 Rev 11-91 <br /> <br /> <br />