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F. OR CITY VALIDATION] <br /> <br />Date: ~/-~(o ' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPIVI~p~NT CENTER <br /> <br /> 8:00am-4:30pm Pho <br /> 2/I hr. Inspe~on Linj~ ~1~-~)~ <br /> FAX 588-7~ <br /> <br /> BUILDING PERMIT APPL~Tm~ <br /> <br />FOR CITY USE ONLY <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH <br /> <br />1. JOB DESCRIPTION <br /> <br />................... RESIDENTIAL COMMERCIAL 'cCO~s'e}'o~3~mre: ~' " <br /> ( ) Addition ( ) Relocation ( ) Addition ( ) New ~ ~ <br /> (L.;f~teration ( )Other ( )Alteration ( )Sign ' <br /> ( )Aocessor~ ( )ChangeofOccup~ncy ( )Other <br /> <br />LOCATION OF INSTALLATION <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br />~ i am the PROPERTY OWNER and own, reside th, or will reside in the completed s/~cture and will be ray own g~ncral contractor. I understand that I must register o~ a construct/on <br /> <br />( ) I am a CONTRACTOR registered wilh the State of Oregon. <br /> <br />() <br /> <br />I am an AUTHORIZED REPRESENTATIVE of the lnOpe~ owner or contractor. <br /> <br /> Marling Addrezs Phone <br /> <br />4. FEE SL-~ll~,DULE <br /> <br />A. <br /> <br />B. Mi~celthneous Fee~ (1) Additional Plan Reviews ot Addendun~ <br /> <br /> (2) Investigation Fee <br /> <br /> (3) RdnsFccfion F~ ~ ~.~ <br /> <br /> (4) ~r hs~fi~ n~ lis~ a~vc <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />NameofAppticant(PleasePdnt):z~.~7~' ".~--~ ~i~ <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />