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[iFO~ CITY VALmATIONI <br /> oning Validation: __ [ <br /> ate: ] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am.4:3Opm Phone $88-5147 <br /> 24 hr. Impectton Line 588.7904 <br /> FAX 588-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />FOIl CIT_~y_Y USE ONLY <br /> <br /> RESIDENTIAL ' COMMERCIAL Use of Structure: <br /> ( ) Addition ( ) Relocation ( ) Addition ( ) New <br /> ( ) Alteration ( ) Other ( ) Alteration ~Sign <br /> ( )Accessory ( )ChangeofOccupancy ( )Other <br />)~s¢fipfion of Work ~ ~~ [ Is this a historical building? <br />Energy Path: I No. Sto.~ I No. of £mploye~: Existing - New- <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner ] Mailing Address Phone No. <br />Subdivision , Lot Block <br />Mobile Home Pa~k ! Spac~ # <br /> <br />Sect/on Township Range Zone Map Water Supply: <br />Lot Width Lot Depth Acr~ lrc~g. Lot Corner Community Well ( ) City ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am an AUTHORIZED REPKE~ENTATIVE of the property owner or coraractor. <br /> <br /> ( ) <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />TOTAL <br /> <br />=$ <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 />Name of Applicant (Please Print): <br /> <br />Phone: <br /> <br />Signature of Applicant: .Date: <br /> <br />MC 15-73 Rev 1195 <br /> <br /> <br />