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iFOR CITY VALmATION] MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> 285 Church St. NE - Room 132 ]City Setback Requirements: <br /> <br />/Zoning Validation: ~ I Salem, Oregon 97301 <br /> 8:00am.4:301maPhoneS88.$14,7 IFt°nt: /~! IRe'an t/~?! <br /> 24 HR !nspeetion Line 588 Let~ Side: I Right Side' ~J <br /> COMPLETE ALL SECTIONS, 1 THROUGH 4 PERMIT APPLICA'In~O~, Js~/,~3 <br /> <br /> (~"Ncw Placement Garage or~da~tYn~"ON ~Dt -' ~ <br /> ( ) Replacement ( ""r'Attach"'~'~tJ/t~/~/~.q~J(J~lt~ <br /> ( ) Additional Unit Add-on ( ) Detached 6~0~/0N <br />Dealers.~.N,~/~ I~ Year of I No. of Length ~ ~ Width <br />S~e: ,%t~m_,.~ Manufact~er 97 S~:ao~ 2~ ' 9-7 g <br />Type of Siding: Type of Roofing: ] Square Footage:/~ No. of Bedrooms: e~ <br />( ..-'fWooa ( ..0nSomp <br />( )Metal ( )Steel PitSet: H~ Energy: d <br />( )Vinyl ( )Metal ~,2t2~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Section: .~ O Township: p ~.~ Range: ~.. ~ Zone: ~ Map: ~ ~ ~ <br /> Lot Width: ~ LotDepth: /pp Acres: lmLot: Comer: <br /> <br /> Urban Growth Boundary? ( ~rYes ( ) No Wa~er Supply: ( ) Private Well ( ) Commuuity Well ( ~'fl2ity <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ( '~ I am tho PROPERTY OI~ER and own, reside in, or wi[l reside in the completed structure and will bc my own general contractor. I understand that I <br /> must register as a ¢onslmction contractor if the structure is sold or offered for sale before or upon completion. If I hire subcontractors. I ,:etil hire only <br /> subcontractors registered with the Construction Contractors Boa~l. If I change my mind and do hire a general contractor who is registered with the <br /> Construction Conlracto~s Board, I will hnmedlately notify Marion Coun~ of thc name of the contractor. <br /> <br /> I am a CONTRACTOR registered with the State of Oregon. <br /> <br /> Mailing .s. ddr~s: ,._.~,~j..~ ~.. Phone: <br /> <br />4. FEE SCHEDULE <br /> <br />Sta~ Surcharge $12.25 = 12. ~ Reinspeetion Fee $60.00 <br />State Fe~ $20.00 = ~0. -- <br /> <br /> TOTAL .~ t ~o ~ <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br /> <br />NAME OF APPLICANT (please print): <br /> <br />SIGNATIJRE OF APPLICANT: <br /> <br />MC 15-64 Rev 3195 <br /> <br /> <br />