Laserfiche WebLink
. FORCITY V~LmAyION <br /> <br />CO1 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 HR Inspection Line 588.7904 <br /> FAX 588-7948 <br /> <br />Left Side: /~ ¢ Right <br /> <br />FOR CITY USE ONLY <br /> <br />1. JOB DESCRIPTION .IUi ~-._ '~Jj <br /> ( ~'~New Placement Garag~o~.r.r~ r~ ~) ~.f~ <br />( )Replacement ( ~*~ch~ MARION COUNTy <br />( ) Additio~l Unit Add~n ( ) Demch*d BUILDINg I~, ~ .... <br />f Siding: Ty. of R~fing: Sq~ Fooage: a ~~ No. of B~moms: ~ <br />~d (~omp <br /> (()) VMylMe~ (()) MemlSeel ~t Set: ~ Energy: ~ ,~ ~ ~ <br /> <br />2. LOCATION OF INSTALLATION <br />'.. ~/t, y'D~--g. ~ <br /> <br /> MailingAdthess' g]/b yO~/~ ~ PhoneNo.: <br />Occppant: Mailing Address: <br /> <br />Section: ,.~ Township: ~' <br /> <br />Urban Growth Boundary? ( ~'j~cs ( ) No <br /> <br />Irt, Lot: ~$~ <br /> <br />Water Supply: ( ) Private Well <br /> <br />( ) Community Well (~-~ty <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections $245,00 = <br /> (Mcludes EL, PL, ME connections) <br /> State Surcharge <br /> <br />B, Additional lnspectiord <br /> (beyond third inspection) <br /> Reinspection Fee <br /> <br />I hereby certify that the above information is correct. Permits a~ 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(ole.~~ PHONE: ,~-,,~t~__// <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />