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FOR CITY VALIDATION <br />Receive~¢y: __ <br />Zoning Validation: <br />l~ate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4g0~m Phone 588-5147 <br /> 24 hr, Inspection Line 588-7904 <br /> FAX 588-7948 <br /> BUILDiNG PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 <br />:l. JOB DESCRIPTION <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requieemeaw. <br /> <br />Front: Real', <br />Left $1d*: Right Side: <br /> <br /> RESIDENTIAL COMMERCIAL I ...... Use of Structure: ........ <br /> <br /> ( )Addition ( )Relocation ( )Addition I ( )New Jot Ski, Snowmobilo, & Boa% <br /> ( ) Alteration ( ) Other ( ) Alteration ( D Sign Showroom. <br /> ( ) Accessory ( ) Change of nco panoy ( ) Other <br />Dcsc:'ipdonofWntk Sale~ ........ i , , I .... Yes - NO <br />SquamP[a~tage-n:~y~nonl: N/A IMainFl°°r: 3,200 [$e¢oad....~oon I~a lGarage: "N/A ........ IOther: N/A II't~[ght: ]-9 <br /> <br />LOCATION OF INSTALLATION <br /> <br />...... ~oneNo 503 7 9 ........ <br />JobAdd~s 11~.1. Mill Creek Rd. .... ~xA~¢~.~0156432_0096 cmsssft:et~lf <br />A~vill~, Ore,on 97385 <br />Su~iviaion N/A ~t 0180~ mock <br /> , , Water Supply: <br />$*cdon 32 Township O~ R~ge ~W ~n~ I,,,,~ Map ~ ..... Pfiva~W~ll (~ Spring ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE ¥ ?HO IS DOING THE WORK <br /> <br /> I nm a CONTRACTOR ~gistorod with the Stat~ 0 f Oregon, <br /> <br /> 049734 <br /> 503-769-5301 <br /> <br />MCCall Building <br /> <br />P,0, Box 105 S~a.V%On. <br /> <br />() <br /> <br />4. FEE SCI-~DULE <br /> <br />= <br /> <br />= <br /> <br />= <br /> <br />(1) Additional Plan Reviews or A&iendums <br />(2) lowsfigation Fe~ <br /> <br />(3) R*insp~tion Fee ~ $25.~ <br /> <br />O) Other Ins~fiona not lis~d a~ve <br /> <br />=$ <br /> <br />TOTAL =$ <br /> <br />P~rmit$ are non-transferrable and expire if work is not start,d within 180 days of issulanco or if work is susponded for 150 days. <br /> <br />Namc of Applicant (Please <br />Stgnatur* o~ Apphcant, / ~g~ ~ //f~ff~/~ __~ae: i 1/08/95 <br /> <br /> <br />