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[FOR C. ITY VALIDATION] <br /> <br /> I <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. I~.qpection Ll~e 588-7904 <br /> FAX 588-7948 <br /> <br />· COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> 1. JOB DESCRIPTION <br /> <br />RESIDENTIAL <br /> <br /> ( ) Addition ( ) Relocation <br /> ( ) Alteration ( ) Other <br /> ( ) Accessory <br /> <br />t PR 2 0 <br /> <br />COMMERCIAL <br /> ( )Addition ~10~ CDU~['[~qew <br /> ( )A.~m~$UILDING INSP~t~ <br /> ( )ChangeofOccu~cy ( )O~er <br /> <br />i FOR CITY USE ONLY <br />~o.t: ~ ~ ~ <br /> rtSide: ~ [m~atsia~-,_.~ <br /> <br />DesefipfionofWork [~.)~Z. ali~'Tt.)~) ~ ~,~'~ .~lZ.,t~J~l~;~'' lsthhahistod¢~lhuilding? y=$ . ~_~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />I Property Owner ~.~'~"~..~',.~ [ MailingAd~ess ~O ~OX <br />~6V~~ ~ q~z~ <br /> <br /> Mobile Home P~k Space <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I ara the PROPERTY OWNER &nd own, reside h~, or will reside in the completed structure and will be my own general eonmaetor. I tmd~rstaq~ that I must register a~ a com~zucfion <br /> coat~actor it' the sm~eture is sold or offer~:l for sale ~fore or upon completion. If I hire subcontractors, I will hh'e only sulgontraetor~ reglster~d w~th the Conmmctioa Contramor* Board. <br /> If 1 change my mind ~md do hire a general con,actor who is registered with the Construction Contractor~ Board, I v~til inunediat~ly notify Marion County of the name of the contractor. <br /> <br /> I am a CONTRACTOR reglstered wlth the State of Oregon. <br /> <br /> Name <br /> <br />4. FEE SCItEDULE <br /> <br />(1) Permit Fee .~/~ -~ <br />(2) 5~ State Su~h~ge (.05 x Al) <br /> <br />~cstrr: .~-~c5-O <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 it' work is ~uspended for 180 days. <br /> <br />$i,natureofAplflicant: ~ ~ Date: <br />MC 15-73 Rev I~5 <br /> <br /> <br />