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FOI~ CITY VALIDATION <br />Received By: __ <br /> <br />Zoning Validation: <br /> <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Chuwh St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am.4:3Opm Phone $88-5147 <br /> 24 hr. Inspection Line 588.7904 <br /> FAX 588-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />FOR CITY USE ONLY <br /> <br />1. JOB DESCRIPTION <br /> <br /> RESIDENTIAL COMMERCIAL Use of Structure: <br /> ( ) Alteration ( ) Other ( ) ,4iteration ( ) Sign <br /> ( )Accessory ( ) Change of Occupancy ( )Other <br /> <br />D~scrlption of Work Ia this a historical building? Yes - No <br />Energy path: ] No. Stories [ No. of Employees: ~xistlng - ~cw- <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Prop~y Owner t'"N M~ailing Address ~'~ Phoae No. <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />on squa~ footage of project.) ~ ~ I~ V%~uati°n:$ ~ <br /> <br />=$ <br /> <br />I hereby certify that thc above information is correct. <br />Permits are non-transferrable and expire if work is not started wilhin 180 days of issuance or if work is suspended for 180 days. <br />Name of Applicant (Pleas, P~nt): .M...t~. _ C~-..~ Phone: <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />