Laserfiche WebLink
I~)R ~ITY.~VALIDATION <br />Re¢~iV~d BY: <br />]Zoning Validation: ~ I <br />[Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Omgon 97301 <br /> 8:00am-4:30pm Phone $88-S147 <br /> 24 hr. insl~ction Line 588-7904 ~ <br /> <br /> JUL 1 3 1990 <br /> <br />¢FOR CITY USE ONLY <br /> <br />RESIDENTIAL COMMERCIAL MARION COUNTY <br />()Addition ()Relocation ( <br /> ( )~afion ( )Other ( ( )Sign <br /> <br /> ( /ffAccessory ( ) Change of Occupancy ( ) Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />S~don ~ Township ~ R~ge ~ ~"e ~ Map ~ W~gu~ly: <br /> <br />3. CONT~RACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> (~i am the PROPERTY OWNER and own, reside in, or will reside in the completed st~cture and will be my own general eontxaetor. I und~stand that I must register as a cormmtndon <br /> <br /> contractor if the stmchim is sold or offered for sale before or upon completion. If I him subcontractors, I will him only subeontzactora mgi~tetnd with the Construction Contractors Board. <br /> If I change my mind and do hire a gcnemi con~ra~tor who is registered with the Construction Contractors Board, [ will imn~diatcly notify Marion County of th~ name of the contractor. <br /> <br />( ) I am a CONTRACTOR reglster~xl with the Stat~ of Oregon. <br /> <br /> ) <br /> <br /> Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />VALUATION (Se~ "Valuation S~hedule" to d~t~rmine valuation based <br />on squa~ footag, of project.) Vnluation: $ /~a~ <br /> <br />(2) Investigation <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 />Name of Applicant (Pleas~ Print): pCP~ ~:~/h ~7 <br />Signature of Applicant: ~ ? ~ C~7~ Da,: <br />MC 15-'/3 R~v 1/95 <br /> <br /> <br />