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MARION COUNTY BUILDI~ INSPECTION [ FOR CITY USE ONLY <br />I <br /> FOR <br /> CITY <br /> VALIDATION <br /> I <br />IR&rivedgy: 285 Church St. NE - Room 132 /Oty Setback Requirements: <br /> Salem, Orego~l 97301 [ ..... , <br />/Zoning *alidationfl ~ ~ ] . <br /> <br /> COMPLE~ ALL SEC~ONS, <br /> 1 <br /> THROUGH 4 <br /> <br /> RESIDE~IAL COMMERCIAL <br /> ( ) Sign <br /> <br /> ) Addition ( ) Relocation ( ) Addition <br /> ) Alteration ( ) Other ( ) Alt,ration <br /> ( ) Change of OoeUFaney <br /> <br />Path: NO, Stories ~t ! I No. of Employees: Exisgng - <br /> <br />LOCATION OF INSTALLATION <br /> <br />I Moiling Addrea~ <br /> <br />/4Z/ <br /> <br />Block <br /> <br /> Section ~ Town~hip {~ .... Map <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WItO I$ DOING TIlE WORK <br /> <br />Community Well ( ) 0ily <br /> <br />4. FEE SCHEDULE <br /> <br /> (1) Additional Plan Reviews or AdOendum8 ~ $ <br /> (2) Inve,qlgation F~* <br /> <br />P~ECEIPT:__,, 93 70 TOTAL =$ __ <br /> <br />I hen*by cee fy that the above information is correct. <br />Nam~ of Applicant (Pleas* Print~~ ~~ : <br />Signature of App~~ ...... Date: __ <br /> <br /> <br />