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~,eceived By: ~ <br />~oning Validation: <br />)ate:-.~__~- ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMEN'I' CENTER <br /> 2~5 Church St. NE - Room <br /> Salem. O~gon 97301 <br /> <br /> S:OOam-4:~Opm Phone 588-5147 <br /> 24 hr. [mpectlon Line S8LTO(O <br /> FAX 58~-794~ <br /> <br />:OMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />· JOB DESCRIPTION <br />RESIDENTIAL '~'~MMERCIAL <br /> ~Addltion ( )Relecation ~( )Addition ( )New <br /> ( ) Alteration ( ) Olher ] ( ) Alteration ( ) Sign <br /> ( ) Accessory =L ( ) Change of Occupancy ( ) Other <br /> <br />BUILDING PERMIT APPLICATION <br /> ¢?.- ?o t <br /> <br />INSPECTION <br /> <br />!ncray Pnth'~'"~~--No. or' Employees: Existing - New - No. Bed~No. Bedmoms=~-' "~ <br />~~:7 Other: :Hei~ht:~' 7'~. <br /> <br />:. LOCATION O.F.INSTALLATION <br /> <br /> ( ) Sl~ing ( ) <br />Commtufity Well ( ) Civ/ ~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />(2) Investigation Fee <br /> <br />(3) Reinspection Fee ~ <br /> <br />=$_ <br /> <br />TOTAL <br /> <br />I hereby certify that the above infotmatlon is correct. <br />Permits are non-transferrable a~d expire if work is not started within 180 days of issuance or if work is suspended for 180 days, <br /> :7~,~z~,:~:_._ ~7.'/~ _~o.~: __~_~F-b ~ 7 / <br />Name o f Applicant (Please Print); <br />SignamreofApplicam: ~ __Dam: ~-- /' ~ 7 <br />MC 15-73 Rev 1/95 <br /> <br /> <br />