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'FOR ~CITY VALIDATION <br />ReCeived By: ~ <br />Zoning Validation: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTI~ <br /> 285 Church St. NE - Room 132 <br /> Salem. Oregon 97301 <br /> 8:00am-4:3Opm Phone 5885147 <br /> 24 hr. Imp~fion Line $88-7904 <br /> FAX $88-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />[a FOR CITY USE ONLY <br />~s~: ID' <br /> <br /> qv-ot <br /> <br />RESIDENTIAL ~OI~I~R~(~IAL Uae of Structure: <br /> (~5~ddition ( )Reoca o~- )~fion ( )New <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> ( )Accessory ~=~,~ ,; ~ ~!~?u~ofOccupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am an AUTHORIZED REPRESENTATIVE of th~ property owner or conU'actor. <br /> <br />Mailing Address <br /> <br />4. FEE SCHEDULE <br /> <br /> A. VALUATION (SCg "Valuation Schedule" to dct~aln~ valuation based <br /> <br />TOTAL <br /> <br />=$ 77, 2t~ <br /> <br />I hereby certify that the above inforraafion is cor~ct. <br />Permits are non-hnmsferrable 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 (Please ~a~ ~$9~,t~a0 Phone: <br />$ignatur~ of Applicant: ~ <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />