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FOR CITY VALIDATION <br />Received By: ~.~ ~ <br />Zoning Validation: ..~ <br /> <br />MARION COUNTY BUILDING INSPECTION __ __~_ __ __ <br /> COMMUNITY DEVELOPMENT CENTER [ FOR CI Y USE ONLY <br /> Salem, Oregon 97301 <br /> <br /> BUILDING PER~ <br /> <br />COMMERCIAL I~UILLIIPI~ I I~,l'~ r ILI <br /> <br /> ( )Additlon ( )New <br /> ( ) Alteration ( ) Sign <br /> ( )ChangeofOccupancy ( )Othor <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />1..JOB DESCRIPTION <br /> RESIDENTIAL '" <br /> ( ) Addition ( ) Relocation <br /> ~ Alteration ( ) Other <br /> <br />Is this a historical building7 <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />~tWM~ ~tDep~ ~ ~ Acres Irmg,~ 'Comer '~:" Co~unityWell ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) I am the PROPERTY OWNER and own, n~qld* in, or will m~ide in the ¢omple~d atmeture and will be my own general eonh'aetot. I understand that I must regismc aa a construction <br /> <br />() <br /> <br />I am a CONTRACTOR registered with th* $~at¢ of Oregon. <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION (8¢~ "Valuation Schedule" to determine valuation <br /> <br />(2) lnwsfigation Fee <br /> <br />I heoeby certify that lhe above information is corrc¢l, <br />Petmit~ are non-transferrab}~ and expire if work is not started wilhin 140 days of issuance or if work i~ suspended for ] $0 clays, <br />Name of Appllcant (Plea$~ Print): ~ /~ Phone: <br /> <br /> <br />