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F~R_ .CITY VALIDATION <br />Received By: <br /> <br />Zoning ValJ, dation: <br />Date: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 hr. Impection Line 588.7904 <br /> FAX 58g-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />FOR CITY USE ONLY <br />Ir','-,t: ,o9..C) <br /> <br />RECEIVED <br /> <br />1. JOB DESCRIPTION " ~ 0 7 1996 <br /> <br />RE$1DENTIAL COMMERCIAL Use of StruG~.~ ...... ~ <br />( ) Addition ( ) Relocation ( ) Addition ( ) New ~N COUNTY <br />( )Alteration ( )Other ( )Alteration ()Sign BUILDING INSPECTION <br />( ) Accessory ( ) Change of Occupancy ( ) Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />S~cllon \ Township ~j Range ~' Zo,, ~%~.~ Map ~ ~_ 0~[~ Wal~r Supply: <br />LotWidth~.~.~ LotDepth ~QI Acres Irreg, Lot Corner CommulfityWell ( ) City '~) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I ara the PROPERTY O~¢rb~R and own, reside in, or will reside in the completed structure and will be my own general contractor, l ~d that I muat register sa a eonam~etlon <br /> contractor if the structure is sold or off, red for sale before or upon completion. If I hire subcontractors, I will hire ovfly subeonn'aOors registered with the Construction Contraeters Board. <br /> <br />() <br /> <br /> Busineas ~ Registration No. <br /> <br />I ara an AUTHORIZgD REPRESENTATIVE of the property own? or contractor. <br /> Name <br /> <br /> Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />Valuation: <br /> <br />B. Miscellaneous Fees <br /> (1) Additional Plan Reviews or Add~ndums <br /> (2) Investigation Fee <br /> <br /> (4) Other Ins tions not listed above <br /> <br />I hereby certify that die above information is correct. <br />Pexmlt$ 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 />NamcofApplicant<PleasePriAt);. ["1"~1~5~' _ //~/'"~:~/'"'~ Phone: <br />S ig.a~rc of Applicant: /3A~ b~~-~ ~ Date: <br /> <br />,c,,.?, // '//"' <br /> <br /> <br />