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FOR. CITY vALIDAT. ION <br />Receiv~ed,By: ~ <br />Zoning validation: ~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENT-I/R <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:O01ml-4:30pm Phone ~-S147 <br /> BUILD~ <br /> <br />FOR CITY USE ONLY <br /> <br />1. JOB DESCRH'TION ,,0~.~! .-~. <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />(I) Permit F~ ~.~. O0 <br />(2) 5% Sram Surcharge (.05 x Al) ' ,~-0 <br />(3) Smlctaral Plan Review (.65% x Al) ~ ~ O <br /> <br />=$ <br /> <br />I h~mby 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 180 days. <br /> <br />SignatumofApplicant: ..~ .~' ~.~ <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />