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iFOR CITY VALIDATION <br /> eceived By: __ <br /> <br /> oning Validation: <br /> <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.4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 588.7904 <br /> FAX 588-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />FOR CITY USE ONLY <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL ' COMMERCIAL Use of Structure: <br />( )Addition ( )Relocation ()Addition ()New <br />( ) Alteration ( ~),~ther ( ) Alteration ( ) Sign <br />()Accessory () Change of Occupancy ()Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ~' i am thc PROPERTY OWNER and own, r~slde ia, or will reside in the completed s~'ucturc and will be my owngene erg] conWactor. I understand that I mu~t register a~ a construction <br /> <br />IFfl:IWI1 <br /> <br />( ) I am an AUTHORIZED REPRESENTATIVE of tbe property owmr or connsct~. <br /> <br />M~lingAddress <br /> <br />MARION COUNTY <br /> <br /> BUILD:NG INSPECTION <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />B. Miscellaneous Fe¢s <br /> (1) Additional Plan Reviews or Addendums <br /> (2) Investigation Fee <br /> (3) Reinspection F~ ~ $25.0~ <br /> (4) Other Inspections not listed above <br /> <br />=$ <br /> <br />T(YrAL =$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not starred within 180 days of issuance or if work is suspended for 150 days, <br /> <br />Name of Applicant (Please Prin0: .~..~ ~.l. ~ 0 ~ ~ ~{~ex, ~.// Phon~: <br />Signature of Appl~t~ ~ Date: <br /> <br />MC 15-73 Rev 1;95 [ [ ] <br /> <br /> <br />