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Fr.O crrv VALIDATION MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> · j~.x "-~'" ~-*~ ¢ ~ COMMUN~YDEVELOPME~CE~R <br /> ~ .... ~v' · ~c~Z~ 285 Church St. NE - R~m 132 <br /> ...... ~-~' ~ ~ Salem Oregon 97301 -.:"~ <br />Z~ning~ali~tion: ~ S:00nm.4:30pm Phone 588.5147/ [rr~u <br /> <br />COMPLETE ALL SE~IONS, 1 THROUGH 4 <br /> <br /> Use o~ Slruc~'e: <br /> KESIDENTIAL COMMERCIAL MARION C~)~[I~, <,- (_ ~ ;~-~'~ <br /> ( )Addition ( )Relocation ( )Addition BUILDING Ittl ] 0N c~o~ <br /> ( ) Alteration ( ) Other ( ) Alteration <br /> ( ) Accessory ( ) Change of Occupancy ( ) Other <br /> <br />:kscriptionorWork /,O,~T.d/.~770,O ~ ,~Ct,~. .~lt~_~.~'~' [hthlsahi~todcalbuilding? Y~s - <br />~ergy Path: ] No. Stories I No. of Employees: Existing - New - ] No. Eedrooras: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) 1 am th~ PROPERTY OWNER and own, reside in, or will ~eside in the completed smtctur¢ and will beyay own general co~xactor. I u~der~tan~ that I must register as a cons~ru¢6on <br /> <br />4. FEE SCHEDULE' '~ ,/~,,S"dP-- <br /> <br />B. bliscellaneous Fees <br /> ( I ) Additional Plan Reviews or Addendum$ ~: $ <br /> (2) Investigation Fe~ <br /> (3) R¢inspection Fix ~ $~.~ <br /> (4) O~er Insertions not listed <br />~CEI~: C~ ~OTAL <br /> <br />I hereby certify that the above information is correct, <br />Permits ate non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days, <br /> <br />NameotApplicant(Plca~eprint): /J ~el'~r~JA ~---~-Ok~on Phone: <br />MC 15-73 Rev 1/95 <br /> <br /> <br />