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FOR CITY VALIDATION <br />Ileceived By: <br /> <br />Zoning Validation: <br /> <br />MARION COUNTY BUILDING_.I~.. ~.ION <br /> COMMUNrrY DEVELOPMSNT CJt~'/~'/,f'-/ <br /> 285 Chumh St. Ng - R~m ~[ <br /> Salem, Oregon 97301 ~/ <br /> 8:00am-4:30om Phone 588-5147 <br /> 24 hr. I~fion Line ~88-7904 <br /> FAX 5~-79~ <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL <br />( ) Addition ( ) Relocation <br />( ) Alteration ( ) Other <br />( ~"~ccessory <br /> <br />FOR CITY USE ONLY <br /> <br />COMMERCIAL <br />( )Addition ( )New / i~,~'+~$' <br />( )Alteration ( )Sign ..~ff~-,~c't~3 <br />( )ChangeofOeeup~cy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />,,,Section ~/ Town,hip ~S Range ~m ~n* "'~m Map Wa~rS~ly: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />(2) 5% State Sueeharge 605 x A 1 ) <br /> <br />(3) Structural man Review (.r,g *z <br /> <br />(5) Zoning Su~h~ge, if applicable (,05% x A 1) <br /> <br />=$ <br /> <br />[ hereby certify that the above information is correct, <br />Permits are no~-ttan~ferrable and expire if work is not started within 180 day~ of issuance or if work }s suspended for 180 days, <br /> <br />MC 15-73 Rev I/9.6 <br /> <br /> <br />