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AT, ON MARION COUNTY BUILDING INSPECTION ! FOR CITY USE ONLY <br /> FOR CITY ~V~'LID/r~~ 285 Church St. NE- Room 132 ]City Sr..fl~aek <br />IP..eceived"By: COMMVhrrr¥ P~V~OPM~r cv_2qr~R I ' <br />IZomgV~lidation: ff g/?" Salem, Oregon973Ol i ~....~_ <br /> <br /> - - ' FAX$$g-79~8 It/,,~l~'~.~.~,~,,'''s~'' ~ K~ <br /> <br /> 1. JOB.DESCR1P~ON I~$X~10R ~,OkJlq"P{ <br /> <br /> ~,fi~&ent ............. C~. g).o~ BUll..~lnu n~o, ,. ...... <br /> Replacement ( ~A~h~ <br /> A~ifional Unit A~R ( ) ~h~ <br /> ~W~ ( ~Comp .... <br />( )Me~ ( )S~, PitSet: ~ ~r~: ~ <br />V~yl ( ) Me~ <br /> <br />2. LOCATION OF INSTALLATION /,~r'/-/~/n ~ <br /> <br />3. CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside irt the compleled structure and will be my own gene~ contractor, t undemtand tlmt 1 <br />mx~ ~gister ~ a cons~'uc6on contractor ff the s~-~mre is sold ot offered f~ sale l~fore or upoa completion, ff [ him subcontractors, I ,.viii him <br />subconWacWrs registered with thc Construction Contractors Boat& If I chang~ my mind and do hire a general contractor who is re~stercd with the <br />Construction Conlraetors Bo,mi, I will immediately ~ofify Marion County of the name of ~ <br /> <br />[ ~x ~ CONTRACTOR ~gistemd with the State of Oregon. <br />I Bt~iness Natne: ~ Registration No.: <br /> <br /> · A ' <br /> <br /> ! am an AtlTHORIZI~D i~RKSgNTATIVg of th~ property owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />B. Additional Inspectioed <br /> (beyond third inspection) <br /> Reinspectioa Fee <br /> <br />I hereby certify that the above informatiott ia conect. Permits are non-transferrable and expire if work is n~t started within 180 days of issuance <br />or if work is suspended for 180 days. <br /> <br />SIGNAI'LIRE OF APPLICANT: . ~' '-'" - ~ ~ ~'-"~l~'%~ ~ DATE: _ <br /> <br />MC 1544 Rev 3/95 <br /> <br /> <br />