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FOR CITY VALIDATION <br />Recoived By:. ~ <br />Zoning ~rdlid~fion: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> L JOB DESCRII~ION <br /> <br /> FOR CITY USE ONLY <br /> <br />Salem, Oregon 97301 t <br />8:00am-4:30pm Phone 588-5147 ' ' / <br /> ,0' <br /> <br /> ( 'Q"New Placement ' Gar~9[ _~J~l~,l~ DUURI I ~ <br /> ( )Replacement (~G INSPECII0fl <br /> ( ) A~itiona[ Unit Add~n ( ) Detached <br />De~e~ ~ ~, Ye~ of ~ No. of ~ng~ Wid~ <br />N~e: ~ M~uf~rer ~ S~tions ~ ~ 2 7 <br />ty~ of Siding: Ty~fing: Sq~ Foo~ge:/~ ~ No. ~f B~ms: ~ <br />(~ ( ~Comp <br />( ) Meal ( ) Stol Pit Set: Ener~: <br /> <br /> CONTRACTOR II'FORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ) I am the PROPERTY OWNER and own, r~ide in, or wiB reside in the completed structure and vail be my own general contractor. I understand that I <br /> must reglstet a~ a cc~m~ion comn~ctor if the structure is sold or offered for sale before or upon completion. If I hire sul~ontractors, I VAIl Idrc only <br /> subeontcactors ~gime~ed with the Con~lruction Contractors Board. If I change my mind and do hire a general contractor who is mgister~l with th~ <br /> Construction Contractor~ Board, I will immediately noti~ Marion Connt!~ of the name of the contractor, <br /> <br />(~ I am a CONTRACTOR r~gimm~d wRh the State of Oregon. <br /> <br />Registration No.: <br /> <br />TOTAL <br /> <br />$t2.2~ = <br /> <br />-~=~ <br /> <br />B. Additional lnspectio~ <br /> (b~yond third inspection) <br /> Reinspection Fee <br /> <br />I hereby certify that the above inforraation is correct. Permils are non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. ~ <br />NAMEOFAPPLICANT(pleascprlnt): ~ ~ ~ ~)~t~:~ PHONE: 7~"7~.~ <br /> <br /> <br />