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R CITY VALIDATION <br />ived By: __ <br />ng Validation: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1..JOB DESCRIlvI~ON <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CBNTER <br /> 28~ Church St. NE - Room 132 <br /> Salem, Ol~gon 97301 <br /> 8:00am-4:30pm ]~aone $88-$147 <br /> 24 hr. lmpect~ LI~ S88-7904 <br /> FAX 588-7948 <br /> <br /> BIJILDING PERMIT APPLICATION <br /> <br /> FOR CITY USE ONLY <br /> <br />City S~ac.k Requireramts: <br /> <br /> RESIDENTIAL ' COMMERCIAL Use of Struclm*c:/ <br /> ()Addition ()Relocation ()Addition ()New ~)~ C~. / ~O]~--n~ '~ <br /> ( ) Alteration ( ) Other ~llteration ( ) Sign <br /> ( )Accessory ( )Chan~eofOccupancy ( )Other <br /> <br />DescdptlouofWork [ Ish~isahhtodcslbuikli~g? ~es - ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />=$ <br /> <br />I her~b~ cen/fy lhat the above informal/on is correct. <br />Permits are non-ffansferrable and expire if work is not s~ted within 180 days of issuance or if work is suspended for 180 days. <br />Name ofApplicant(PleasePrin0: {'~,{(~- ~%' ~'J Phone: <br /> <br />MC 15-73 Rev lt95 <br /> <br /> <br />