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FOR CITY V~LIDATIO~ <br />Received By: ~ <br />IZoning Validation[ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 28.5 Church St. NE - Room 132 <br /> Salcm, Oregon 97301 <br /> 8:00am4!30pm Phone 58S-$1a7 <br /> 24 hr. Inspection Line 5884904 <br /> FAX 588-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />i. JOB DESCRIPTION <br /> <br />Iclt~ 5~~~?Slg ONLY <br /> Front: I p. ear: /~ t <br /> <br />P, JE~'iDENTIAL '" COMMI~RCIAL ......... Use of Structure: <br /> <br /> ( ) Addition ( ) Relocation ( ) Addition ( ) New /e:~ ~ ~.~oe- <br /> ( ) Alteration ( ) Other ( ) Alt~tion ( ) Sign ~~ <br /> ( ~Accesso~ ( ) Chmge of Occupancy ( ) Other <br /> ..............., <br /> <br />LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO iS DOING THE WORK <br /> <br /> ( ) I am th, PROPRRTY OWNER and own, reside in, or will msid~ in the completed structure and will be my own general conk'actor, I understand that I must register aa a crmimleli0n <br /> <br />4. FEE SCItlgDULE <br /> <br />A. <br /> <br />(1) Additional Plan Reviews or <br /> <br />(2) Investigation Fee <br /> <br />(3) R¢insp~tion Fee @ <br /> <br />(e~) O*h~r Insertions not listed abeve <br /> <br /> (5) ~/0ning Sur~be~g¢. if applleabl* (,05% x Al) = / <br /> <br />Per. Rs a..on-transferable ..~ expi~ if work is .or st~ w'~in 180 flays of issa~ee or~ is~dff ~ '~s, ~ <br /> <br /> <br />