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[FO.I-CITY VALIDATION MARION COUNTY BUILDING INSPECTION <br /> I .// · ~,/ COMMUNITY DEVELOPMENT CENTER <br /> Received BY: ,,~~ 285 Churoh St. NE - Room 132 Icily s~ <br /> - ~ : .... Salem Oregon 97301 ..... .. - <br /> ZoningValidati.on.: ~ :~v~ ~ $:b0l~m.4i30pmPh0neSg$.Sl4? <br /> <br />COIV~LETE ALL ~EC~iO'NS, i ~THR~uGH 4 .... ~ ' ~/flg~i-~ ~;~d~ ' <br />1. JOB DESC~ON ..... ~e~ <br /> <br />2, LODTI~ OF.~ST~LA~N ~0 ~ ~ <br /> <br /> ~tWidfi ~/~ ~tD~th ~/~ A~s ~/~ ~g.~t ~ ICom. ~/~ <br />3. CO~O~ IN~O~ON ~ PLEASE INDICATE W~O IS DO~G THE WO~ <br /> <br />Warm' Supply: <br />Privat~ Well i ) Spring <br />Communit~ Well 4 ) City <br /> <br />! am a CONTRA~CTOR ~gqstet'~d with the State o f Omgo,~. <br /> <br />4. FEE SCHEDULE <br /> VALUATION- Based on sgu_ar~.footage: <br /> <br /> TOTAl: ~ = ~./f~.~$ ~ I 3. P~ Review F~ (A-2) <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for instrucflohs. <br /> <br />I hereby ce~ify that the above information is correct: perm!ts are non-t~ansferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. <br />Narae of Applicant (Please Print): '~ "~'~%~.~ ~ ~.,O~ L,,, Phone: <br />Signature of Applicant: ~ ~'~4'" ~'~ Dat.: <br />MC 15-80 Revl/96 <br /> <br /> <br />