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~F~OR'C.'TY VALIDATION <br />Received By: __ <br /> <br />Zoning Validation: <br /> <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CE,NTE~ <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30p~ Phone ~88-$147 <br /> 24 hr. Inspection Line S~.7~4 <br /> FAX 5~.794~ <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />FOR CITY USE ONLY <br /> <br />RESIDFAWFIAL COMMERCIAL Us~ of Structure: <br />( ) Addition ( ) Relocation ( ) Addition ew <br />~Accesso~ ( )Chang¢of~eup<cy ( )O~er <br /> <br /> / <br />2. LOCATION OF INSTALLATION ~ ~/-~ gc~ ~'- /~/ 30 F <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) I am an AUTHORIZED REPRESENTATIVE of thc pmpe~y owner or comractor. <br /> Name <br /> <br /> Mailing Address Pho~v <br /> <br />4. FEE SCHEDULE <br /> <br />on square footage of project.) Valuation: <br />(1) Permit Fcc ,~_ ~ <br />(215% S~ate Surcharge (.05 x A I ) *' ~-2 <br />(3)Stn~cturaIPlanR~vicw(.f5%xAl) ~ ~.~' {~/~- <br /> <br />TOTAL <br /> <br />~$ <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 />Name of Applicant (Plesse Print): ~c~/~$ ~' ~--" '~'. ~-- Phone: <br />MC 15-73 Rev 1195 <br /> <br /> <br />