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~y VALIDATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> 8:OOam.4:3Opm Phone 588-~147 <br /> <br /> FOR CITY USE ONLY <br /> <br /> City Setback Requirements: <br />IF~: io' I~: I0' s <br /> <br /> ..SS~SN~ ~ co~mcinc UAFIION ¢~-U~NTY <br /> <br /> ( ) Alteration ( ) Other I ( ) Alteration ( ) Sign <br /> <br />Square Fcotage -Basement: <br /> <br />,l~o..so. <br /> <br /> c,o~ st~.t <br /> <br /> Block <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONT~CTOR ~FO~TION ~ PLEASE ~ICATE ~O ~ DO~G ~ WORK <br /> <br />4. FEE SCHEDULE <br />A. <br /> <br />(2) I~ves~igation Fe~ <br /> <br />(3) Reinspcctlon <br /> <br />(4) Other Inspex'6ons not ~ted above <br /> <br />=$ <br /> <br />TOTAL <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not slated within 180 days of issuance or if work is suspended for 180 days. <br /> <br />NameofApplinant(Ple.sePrint):~ ~ ...~O *~' &~' _._.~_.~Phone: <br />Signature of Applicant L'-I~:~*~::~'~'''~'~'~-~a--~ .Date: <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />