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IsoR Cwv VALIDATION I MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br /> - ,- : '"'~ .O ~ J COMMUNITY DEVELOPMENT ~R [ <br /> · ~ , 285 Church St. NE - Room 132 City Setlmck Requirements: <br />Il~lvCd- By' ~ galen% Oregon 97301 <br />IZoningValidation: ~'" ,e'5~.,~'' ] 8:00am..4:30pmPhoneS88-$147 I~t: <br />Ir~.. q--~'~ ~'~ I 7,4 HR Inspection Lin~ g88-790~ <br />|"*"~': -- "'- "-"'- I FAX S~$-7948 /,U.~/~;~.~-. I ~'-' I <br /> <br /> COMI~X~ nl~ S£C~ONS,, tSmOUOH ~ PERMIT APPLi~ara~in-- <br /> ].joso SCRnmON S /o ! <br /> <br /> ( )Replaceraent ( )Dctachexi "~'0' <br /> ( ) Additional Unit Add-on <br /> <br />D~alers .l~.~a~-.,L- Year of f No. of Length ~Ol/O~/ Width <br />Name: /0~.O~xd ~ ' Manufacturer ~ I S~oa~ ~ 6/ ~ ~- 7 <br />Type of Siding: Type~9~Roofing: Square Footage: ]~.. ~ ~ No, of Bedrooms: <br />('~'~Wood ( ~ Comp <br />( ) Metal ( ) Stael Pit Set: Energy: ~.~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Irt, Lot: <br />WatexSupply: ( )PrivateWe~l ( )ComtaunityWell <br /> <br />U~oa~ Growth Souaduy? ( ~ ( ) No <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( p~l am an AUTHORIZED/REPRESENTATIVE of the property ovrner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />$12.25 = /an~' <br />$20,00 = ...~, ~' <br /> <br />B. Additional Inspection/ <br /> (beyond third iaspeefion) <br /> R~insl~etlon Fee <br /> <br />$60.00 <br /> <br />I hereby certify that tho above information is correct. Permits are non-transferrable and expire ~f work is not started wflhm 180 days of ~ssuance <br />or if work is suspended for 180 days. · <br />NAM~OFAPPLICANT(pIoaSO '~ ~0~-' 7~- 7~q <br /> <br />MC 15~ I~v 3/95 <br /> <br /> <br />