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[~OR CITY VALIDATION I MARION COUNTY BUILDING INSPECTION ] FOR CITY USE ONLY <br />[ ~ ~ I ...~ COMMUNITY DEVELOPMENT CENTER I <br />]Re.ceived By: ~,~~ 285 Chumh St. NE - Room 132 I¢iw ~k ~: <br />I ' · ~/ ' | Salem, Oregon 97301 <br /> <br />[Date' ~,~ _/~ ~ ~ 24 hr; InSpection Line 37a~4427 <br />/ ' -- --e ,r r~ FAX588-7948 _~r-ac'~C'~'N | <br /> <br /> Two <br /> <br />COMPLETE ALL SECTIONS, 1TI-IROUGH 4 I1\%~' '-' <br /> <br />New Single Family Dw~a§ With A~auh~d C, mage <br />New Single Family Drilling With Detached Gal'age <br />) New Duplex <br /> <br />{ Detached Garage Height: No. Bedrooms: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Sp~ag ( ) <br /> <br />() <br /> <br />~1~ prat) <br /> <br />Mailing Addr~s Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on square foo~o: <br />Oarage Sq x 16.27 <br /> <br />Dwelling labels must be obmlned at Marion County Building Inspection and must be placed at the Jobslte prior to inspection for plumbing, el~trical and <br />m~ehanieal work. Contact Marion Connty for instructions. <br /> <br />I h~'~by certify tlxat th~ above information is con~. permRa are non4ransf~rable and expire if work is not sm'ted within Ig0 days of issuan~ o~ if work is suspended for <br />180 days. <br />Name of Applicant (Please Print): (~~~d~ ~ ~ ~~ Phone: / ~'~3 %~ ~e"~ ~'~/' <br /> <br />Signam~ of Applicant: -- ~--/~e/--q 7 <br /> <br /> <br />