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FOR.CITY VALIDATION <br />Received By: ~t- :g ~ <br />Zoning Validation: /o.w~ <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 $~8-$147 <br /> 24 HR Inspection Line S88-TgQ4 <br /> FAX ~8-7948 <br /> <br />FOR <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 PERMIT APPLICATION <br /> 1. JOB DESCRIPTION <br /> <br />) Additional Unit Add-on ( ) Detac3ed <br />Nam¢:~?~_~e~.! 8 Manufacturer ~(ff Sections <br />Typc~ff Siding: Type of Roofing: <br />Wood ( ~'~omp Square Footage: ,/~'0 0 No. of Bedrooms: <br />Methl ( ) St~l Pit Set: Energy: <br /> <br />2. LOCATION OF INSTALLATION <br />Job Address'.~t ~ ~ ~gff ~.~)~~s~' ~~y~ I T~ A~ount. 9:~ ~ C~s S~,:~i ~' ~ <br /> <br />s o.: .3'0 <br /> <br />LotWidth: ~3 ' Irt. Lot: Comer: <br /> UrbanGmwthBom~la~? (.~Yes ( )No WaterSupply: ( )PrivatcWell ( )CommunltyWell (~,"yCity <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING Tile WORK <br /> ( ) ! am tl~ PROPERTY OWR~R ar.d own. re, de in. or will reside in the completed structure and will be my own general contractor. I undexstand that <br /> <br />Address: <br /> <br />4. FEE SCHEDULE <br /> <br />B. Additional Inspectiorff <br /> (beyond third i~speefion) <br /> R~inspectlon F~e <br /> <br />$60.00 = <br /> <br />or if work is suspended for 180 days. <br />"AMI~ OF APPLICANT (@,~ase print): ~ ~ <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />