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FoR CITY VALIDATION MARION COUNTY BUILDING INSPECTION ] FOR CITY USE ONLY <br /> · ~ /, COMMUNITY DEVELOPMENT CENTER -- -- <br /> Rece!ved By; ~[ 285 Church St. NE - Ro0m 132 [City S~tba~;k Requirements: <br /> /~.d ~,/~ + Salem 0~n97301 I .............. , .... <br />IZo~i,~w~iatio.: z-~-~[ ~:00~.~:~0~,~-~m I~'. /~' I~-'~ /~' <br />[Date: ~- / ~ hr. Im~etion ~5~7~ <br /> <br />i. JOB DESC~PTION <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />SuMivi~ion Lot Block <br />~tWid[h ~',, , LotD,p~ ~d' Ae.S Img,~t ~ Comer ~O ~mmunityW.ll ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING TIlE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />TOTAL <br /> <br />=$ <br /> <br />I hereby certit}, that tile above intbrmation is correct, <br />Permits are non-transferrable and expire if work is not started within 180 days of issaance or if work is suspended for 180 days, <br /> <br />MC 15-73 Rev 1/9~ <br /> <br /> <br />