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[FOR'CITY V/~LTA~'TION <br /> ee~ivcd By: ~ <br /> ning Validati~f :,~?___~_~_~ <br /> ate: ~ <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />1. JOB DESCRIPTION <br /> <br /> RESIDENTIAL COMMERCIAL <br /> <br />( ) Addition ) Relocation ( ) Addition <br />( ) Alteration ) Other ( ) Alteration <br />_~) Accessory ( ) Change of Occupancy <br />D~efipfion of Work .- / ~, t' <br />Energ~ Path: yees: Existing - New - <br /> <br /> FOR CITY USE ONLY <br /> COMMLTN1TY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 ~ L'ity SetbackR~qutrem~ots: <br /> Salem, Oregon97301 ~i'~"~:7 ~,r-, ~ ~.~ <br /> 8:00am-4:3Opm Phone 588.$147 . ; : ~rone /~ !- '?- ~ ' ~) / <br /> ~4hr. ImpectionLine$88-7904FAX588.7948 ' (~i, L~Side: <br /> <br />BUILDING PERMIT APPLICATION - )J ~6 ~ <br /> MARION COUNTy ,~. _ <br /> <br />~)New <br />( ) Sign <br /> <br />( ) Other <br /> <br />2~ LOCATION OF INSTALLATION <br /> <br /> Mobil~ Home Park <br /> Section Map <br /> <br />Block <br /> <br />Water Supply: <br />PcivateWell ( ) Spring ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> () <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br /> on sqt~-e footage of project.) Valuation: $ <br /> ~.¢~ <br /> <br />B. Miscellaneous Fees (1) Additional Plan Reviews or Addm~dums <br /> <br /> (2) Investigation F~ <br /> <br /> (3) Reinspection Fee @ $25.00 <br /> <br /> (4) Other Inspections not llst~d above <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transfeaxable and expire ff work is not started within 180 days of issuance or if work is suspended for 180 day s. <br /> <br />:'cgn las.~ o fR: lp[::ant: ~ _Date: ~ <br /> <br /> <br />