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FQR C/TY VALIDATION I <br />R eivedBy: <br />Izomgv .on: I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:3Opm Phone 588-5147 <br /> 24 hr. Inspection Line $~8.7904 <br /> <br />FOR CITY USE ONLY <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH <br /> <br />1. JOB DESCRIPTION <br /> <br /> RESIDENTIAL COMMERCIAL <br /> ( )Alteration ( )~er ( )Mtemtion ( )Sign <br /> ) Accesso~ ( ) ~ge of O~paney ( ) ~her <br /> <br />~gy ~ No. st~, / I No. ;e mploy : Emang J N~w- <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />I am the PROPERTY OWNER and own, reside in, or witi reside in the complet~l stcuctute and will I~ my own g~nend contzaetor. I unddrstand that I must register as a constt~don <br /> <br />() <br /> <br />~o~ 3&3-1711 <br /> <br />4. FEE SCHEDULE <br />A. <br /> <br />oa squm~ footage of pw/ect) Valuation: $ ,.-~Jl~:~, <br /> <br />(1) Additional Plan Reviews or Addendums <br /> <br />(2) Investigation Fee <br /> <br />(3) Reiasp~ction Fe~ @ $25.~0 <br /> <br />(4) Other Inspections not listed abov~ <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct, <br />Permits are non-transferrable and expim~ work is not started within 180 days of issuance or if work is suspended for l g0 days. <br />Nam¢ofAppllcant(PleasePrint): p~' '~,f' Lt~_~, Phone: <br /> Date: <br />MC 15-73 Rev 1/95 V (~ <br /> <br />'7 iq-7? q <br /> <br /> <br />