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FOR C,'IT~ vALIDATION MARION COUNTY BUILDING INSPECTION I ~OR CiTY IJSE~NL~/ <br /> ,,~ . / COMM1)N1TY DEVBLOPMB~ CE~R [ ..... <br /> Recei <br /> By: <br /> 285 Chu[~ St. NE - R~m 132 ~Chy Setback ~irm~at~: <br /> <br /> BUILDING PE~IT APPLICAI~ · ~ . ~ <br />COMPLETE ALL SECTIONS, L THROUGH 4 / [ <br /> <br />1..IOB DESCRIPTION <br /> <br />RESIDENTIAL COMMERCIAL <br /> <br /> ( ) Addition ( ) Relmation ( ) A~lditlon <br /> ( ) Alteration ( ) Other ( ) Alteration <br /> ~cecssory ( ) Change of O¢ou@aney <br /> <br />"~".o.VO' I 'N~ <br /> New <br /> <br /> Sign <br /> <br /> Other <br /> <br />Z. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am thc PROPERTY OWNER and own, reside in, or will reside ir~ tl~ completed ~msetur~ and will b¢ my own gen~ con~cto~, I undcr~tand that I mu~t ~gia~r as a tone,motion <br /> <br /> I am a CONTRACTOR ~gist~ with th~ S~tc of Oregon. <br /> <br />( ) <br /> <br />4. FEE SCHEDULE <br /> <br /> (~) Petit Fe* ~ <br /> (2) 5% State S~:mhar~ (.05 ~ Al) = ~*~ <br /> (3) 8tme~l Plan Review (,65~ x A~) ~. ~ <br /> <br />I hezeby certify lhat the above in formatiotl is correct, <br />Permits arc non-transferrable and expire if work is not started within 180 days of issue.ace or if work is suspended for 180 days, <br /> <br />MC 15-7,3 Rev 1/~ <br /> <br /> <br />