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'- FOI~ CITY~,VALIDATION_ '~ L] MARIONco~m~zvCOUNTYDEvEm~mNTBUILDINGcEN~RINSPECTION~[ FOR CITY USE ONLY~ <br /> Re~ved By: G ~ ~ ~4/~ :85 Ch~h SL ~- Room 132 I~ ~t~k Requi~ts: <br /> . I ~11 ~ [ S~em, ~gon 97301 <br /> ZoningValidatmn: ~~ a:~am4:30~mehoaeS~S147 [Front: ~ ~ ~ <br /> Date: ~ / 24 hr. Ius~;ffs~ed73~27 I~asldo: ~ ( Ri~tSido~ ~ <br /> ONE & TWO FAMILY BWELL~G PE~T APPLICATION <br /> *Includes el~ca~ mech~ieM, pin.lng fees <br /> <br /> I. JOB DESC~TIO~ G~' 0~*~ <br /> ( ~ew Sidle F~ily ~elling Wi~ A~ached Gamg~ <br /> ( ) N~ Singl~ F~ily Dwell~g Wi~ ~ach~d G~ ~ . ~1 <br /> <br />( ) New Duplex <br /> <br />Encrgypath:e~.pi~ ~. )No. Stories ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />At' IfTM ST, 1 <br /> <br />Community Well ( ) Cie/ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I ara thc PROPERTY O~ and own, r~id¢ in, or will reside in the completed structure and will be my own §cn~xal contYac~r. I andorsta~d that I m~st re$~st~r as a v~nst~ction <br /> contractor if the stn~m~ is sold or offered for sale I~ fore or upon completion. If I hire sub~ontractom, I will hire o~ly subcontractors mgis~red with the Construction Conh'aotors Board. <br /> ifI ehang~ my mind ~nd do hire a geaexal conhractor who is register~i with the Construction Contractors Board~ I will imm~diamly notify Marion ComB' of the name &the e~ntractor. <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />7. Otl~r inspection $40.00/pet hr (1 hr min.) = $ <br /> <br />lSO days. <br />Name of Applicant (Pi~~ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and mast be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby certify that thc above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br /> Date: .~'--/-- 9 ? <br /> <br /> <br />