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Received By: ~ <br />Zoning Validation: <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 <br /> <br />MARION COUNTYi BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Chumh St, NE - Room 132 <br /> Salem <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requirements: <br /> <br /> I <br />Right Side: <br /> <br />sos D SCmVrION <br /> <br /> ' 7 r~Jse of Structure: <br />( ) Addition ( ) Relocation ( ) Addition [~~ ~'[Ol~ <br />(.)~Iteration ( )Other ( )Alteration,[ ( )Sign <br />(]~Accessory ( )ChangeofO¢~uplmcy ( )Oflaer <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> e s I <br />SubdJvlslon I ~t Bilk <br /> <br />Mobile Home Par~ ~ ~/~ ~r~ ~r~S ! ....... Space~ ~ <br />S<tion ~ Townahlp ~.5 ..... R~ge ~ ~nei ~.. Map Wa~cSupply: <br />L0t Wid,h ~t LotD~...~r Aemq Meg~ ~t ~ Comer ~ Community Well Privam W~II (()) CitySpring (()) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( ) <br /> <br /> ( ) <br /> <br />d <br /> <br />/ <br /> <br />4. FEE SCHEDULE <br /> <br />(1) Permit Fee <br /> <br />(2) 5% State Surcharge (.05 x Al) = <br />(3) SIrucn~ral Hah Review (.65% x Al) = ,~,,~ <br /> <br />(5) Zoning Surcharge, jf applicable (.05% x Al) <br /> <br />=$ <br /> <br />TOTAL <br /> <br />i he~eby certify that the above information is corn:ct. <br />Permits are non-trans ferrable and expire if work is not star,ed within 180 days of i~suanee or if work is suspended for 180 days. <br /> <br /> <br />