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FOR CITY VALIDATION] <br />Zoning Valiation: ~--~ I <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <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. Inspection Line 588.7904 <br /> <br />RESIDENTIAL__ Addition <br /> (~) ( ) Relocation <br /> <br /> ( ) Alteration ( ) Other <br /> ( ) Accessory <br /> <br />COMMERCIAL <br /> ,: )Additi,~ARlON COUNTy )New <br /> ( )Aitl}.~,~DING INSPECT~O~ig. <br /> ( ) Change of Occupancy ( ) Other <br /> <br />cFOR CITY USE_ ONLY <br />[L~ft Side: S/ Right Side: 5' /' <br /> <br />~nergy Path: ~ ~: Existing - <br />gquam Footage -Bas~menl: ~ jMain Floo,: ~ k Second Flora: <br /> <br /> Use of Sltucture: <br /> <br />Is this a historieai building? Yes ~ <br /> <br />New - <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner ~/- . ' Marling Address <br /> <br />Mobile Home Park <br />Section t ~-~T°wnshlP ~ Rmage ~Zone <br />Lot Width ~ J-- -'-' At, res Irreg. Lot <br /> <br />2 <br /> <br />Space # <br /> <br />Map <br /> <br />Cross Strut <br /> <br />Block <br /> <br />W~er Supply: <br />Private Well ( ) Spring <br />Communi~yWell ( ) Ci~y <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE VOIO IS DOING THE WORK <br /> <br /> ~ own, in, or the completed structure and will be my own g~n~ral contractor. I tmdm'stand that I must register as a constrocfion <br /> the <br /> PROPERTY <br /> OWNER <br /> <br /> If I change my mhid and do hire a genera] contractor who ls registered with the Cnnstmction Con~ractors Board, I will immediately notify Marion County of the name of the conh-actor. <br /> ( ) I am a CONTRACTOR registered with tbe Stat~ of Oregon. <br /> Business Name Registration No. <br /> <br />4. FEE SCHEDULE <br /> <br />Valuation: $ ~ i <br /> <br /> t4,3~ <br /> <br />I hereby certify that the above information is correct. <br />Permits 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 />:;' nTf7 °fR~P/197~Date'' : ' ~ <br /> <br /> <br />