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Received By: ~ C.., <br /> <br />Zoning Validation: <br />Date: __ ~"- ~'~-~' <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> Salem, Oregon <br /> 8:00am.4:30pm Phone ~)~/e~ ~ ~q ? 7~ ~--~ <br /> 24 hr' Inspeeflon Line ~1}- ~,~ ~ ~.~ <br /> <br /> BUILDING PERMIT l~al~I(]~O.~- <br /> <br />RESIDENTIAL <br />( ) Addition ( ) Relocation <br />( ) Alteration ( ) Other <br />(~ Accessory <br /> <br />COMMERCIAL BUILDING <br />( )Addition ( )New <br />( ) Alteration ( ) Sign <br />( )ChangeofO¢cupancy ( )Other <br /> <br />No. of Employees: Existing - New - <br /> I <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Owner tqOSC <br /> <br />Subdivision ~-~i~_ ys~ rvx~ p.~~ <br />Mobile Home Fatk <br /> <br />Lot Width/fro <br /> <br />Lot Depth /O O I Acres I ~eg. Lot~ <br /> <br />363 ¢ ~, '4.S <br /> <br />Water Supply: <br />pdvato Well ( ) Sp~h~ ( ) <br />,Corm~u~y Well ( ) City ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) i am the PROPERTY OWNER and own, reside in, or will reside in th~ completed smic~u~e and will be my own gene~ co~, 1 u~ ~t I mu~ ~a~r ~ a ~c~ <br /> <br />4. FEE SCHEDULE <br /> <br />A. VALUATION (Se~ "Valuation Schedule*' to d~ermine valuation based <br /> <br />onsquamfootageofprojecc) { ~,~ / <br /> <br />Valuation: <br /> <br />w~ =st/t-.7.5 <br /> <br />I hereby ce~d fy that the above information is correct. <br />Permits are non-trans fencable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />SlgnatureofAppheant ~ Date: ~ <br /> <br /> <br />