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)R CITY VALIDATION MARION COUNTY BUILDING INSPECTION F U E N <br /> COMMUNrrY DEVELOPMENT ~ENTER <br />:eived By: ~ ~ 2SS~hSLNE - R~m 132 <br /> S~e~ O~go~ 97301 _ <br />ting Validation: ~ ~ 8:~m4.~pm' ~o~ 5~5147 <br /> <br />~ID~L TCO~ERC,AL <br />(~ A~ition ) Rcl~alion [ ( ) A~ition ( ) <br /> <br /> ( ~Alte~tion }u~r ] L / <br /> <br />.OCATION OF. INSTALLATION <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />FEE SCHEDULE <br /> <br />(3) Rd.spec~ion Fee ~ S~.0O <br /> <br />hereby certify that the above information is correct. <br />'ermits are non-transferrable and expile if work is not sta.~d within 180 days of issuance or if work is suspended for 180 days. <br /> <br />{amc of Appheam (Ptease Print): Phone. <br /> <br /> <br />