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FOR CITY VALIDATION <br />R~ceivcd By: ~ <br />Zoning Validation: /g~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Chinch St. NE - Room 132 <br /> Salem, Oregon 97~01 <br /> 8:0~un-4:3Opm I~one 588-514'7 <br /> 24 hr. Inspection Une <br /> FAX 588.7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requbements: <br /> <br />ere.,: ID < ~ /0 f <br /> <br />1. JOB DESCRIPTION <br /> <br /> RESIDENTIAL COMMERCIAL Use of SWacture: '] ' ' - <br /> ( )Addition ( )Relocation ( )Addition ( )Nuw <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> .~Accessory ( ) C~nnge of Occupancy ( ) Other <br />D~scfipfionofWork C~f}:o/'.''~''1 Stofi~ [Isth..histmicnlbuildln.? Ye~ - No <br />Energy Path: s [ NO. of Employees: E~xisfing - New- ' { No. Bedrooms: <br /> <br />2. LOCATION OF INSTALLATION ' , : ~,,~_.. <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />Registration No. <br /> <br />( ) I am an AUTHORIZED REPRESENTATIVE of the prope~y owner or con~ractor. <br /> NMTmg Add.ss <br /> <br />4. FEE SCHEDULE <br /> <br />on square fo~.age of project.) Valuation: $ ~'~01 ~' <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 />NamcofApptic~nt(PleascPrint):.'~OAtt) ~('a~'~--.- ~. Phone: <br /> <br />MC 15-73 Rev 1/95 ~/ <br /> <br /> <br />