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<br />
<br />FOR CITY VALIDATION
<br />
<br />RtS,eived.-By: ~--
<br />Zoning \lalidation: ~'"-
<br />Date: '1 ,"<L~
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br />COMMUNITY OEVELOPMENT CENTER
<br />2R5 Chu,-ch SL NE " Room 132
<br />S,]em, O'cgon 97301
<br />8,00am-4,30pm Phone 588-5147
<br />24 hr. In'peetion Uno 588.7904
<br />!'AX 588-7948
<br />
<br />FOR CITY USE ONI"V
<br />
<br />City Sotb",' R'qui"","",
<br />
<br />( ) Addition
<br />( ) Alteration
<br />W Ae«"my D <U.\(.
<br />
<br />( ) RcJoea<ion
<br />( ) O'he,
<br />
<br />COMMERCIAL
<br />
<br />( ) AddItion
<br />( )Altc'a<lon
<br />( ) Ch,ng, of Occup'ney
<br />
<br />
<br />( )New
<br />( ) Sign
<br />( ) O'he,
<br />
<br />COMPLETE ALL SECTIONS, 1 THROUGH 4
<br />
<br />1. JOB DESCRIPTION
<br />RESIDENTIAL
<br />
<br />BUILDING PERMIT APPLICATION
<br />
<br />D",,'p';OO"fW~~ ~
<br />E"",y P"II" ---1:'~'
<br />;;;;:;:-;;;;;;;:;;:8",'m"'~' ~]~=---.-
<br />
<br />"thi""""";""'bu"";,,? y" ' ~
<br />
<br />No. 01 Emp]oy"" E""i", ' N',~, d~ :~~:oom" . ',-,-
<br />'"o",C]co" '-._, G"CO'~._:=JOth""'lr'/,1_~t~,-,
<br />
<br />
<br />Job Add,.."
<br />
<br />Suhdl,i,io.
<br />
<br />S""o"
<br />
<br />Lo'Width
<br />
<br />3. CONTRACTOR INFORMATION - PLEASE INOICA TE WHO IS DOING THE WORK
<br />
<br />Spd", ( )
<br />Ci<y~
<br />
<br />( )
<br />
<br />[ 'm th, PROPERTY OWNER "" own, ,.,id, I" '" will co,I", i" 'h, eomp]",d "root"", ond will be my Owo g""",] eo"""'to,. [ u"d"""", th" ¡ mu" co,i"" '" , ","",."""",
<br />,ont""", if Ih, """nt" ¡, "']d °' off'cod fo, ",], Mo" 0, "pon 'ompl",o". II ¡ hi" ."'b""""'«o,,, I will h'co O"'y ",bo"ot""o" "Sl"",d with th, Co""ruo"oo COO""""", "O"".
<br />rlI ,h,"go my mi"d'od do hJ". ",",co, oo"""'o,who "COS;,t=dwith th,Con"ru,"" Co"~'"'oco Bo"d.1 w;u Imm'dl""y OOhly M'rioo Co"",y oftl" ""m, of the '""",,to,.
<br />
<br />( )
<br />
<br />
<br />( )
<br />
<br />4. FEE SCHEDULE
<br />
<br />A. VALuAT[ON (S" "V,Uu"I"" S"',du]o'" 10 '¡"I"""" vo]""tio. b"oJ
<br />oo'qo"'~)otagoofp'Oj",.) V.I"'tioo: $ 3()()(')<::J::)
<br />(I)P'nnitP" 3 'i? 50
<br />(2)5%Sta"Sureh",g'(,O5xAI) 1'1'3
<br />(3)St"","col PIon R,vi,w (.6$% x A!) J ",".C\<
<br />(4) Fico & Llf'S,I«y PI,. RoYi,w (.40% x AI)
<br />(5) Zooio. Sure""",. If "ppH"b], (.05% x AI)
<br />(6) S,i,ml, Sureh",.o
<br />
<br />ß. Mi".I1"",o,,, Po"
<br />(J) Additi"", PJ" R,vl,w,", Add",dum,
<br />
<br />=.1----.
<br />
<br />
<br />e
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<br />/f..,
<br />
<br />I'bo",
<br />
<br />Sð3-
<br />
<br />3
<br />
<br />-:;s¡S?
<br />
<br />q¡ ¡ov"tiS"'o" P"
<br />(J) R,i"'p",I"" P" @ $25.00
<br />(4) Ot"" ["'p"t'"", "01 """",""" c.~'1 't"4 ,\°',09
<br />RECruIT, ..j TOTAL = $ 15.~l¡L
<br />\~và Vki.15
<br />~.J,jì6
<br />
<br />~-
<br />
<br />I h,...by ccrtify th.. the ahovo i"forn¡,lion is correot.
<br />P"'-mi" '... non.tr"'sf"'-",bk 'nd «pi" if wock is 'ot ""'ed withi" ISO day, of i"..n" 0' if wo,k is '"'p""ded for ISO daY',
<br />
<br />Na",eofAPPlk""'(PI"'~~, 1--1 t4Rþl r--, " , " , ,Yoon, 0; ~'" , ~ &,3--2, ,'=3, :LS.2", --
<br />Slgnato'cofAppllc.n" '~~ ,---:;41-~ -"-.-,-__D."" -t:2...~f!!l.'::2r_~__-
<br />MC 15-73 R" 1/9.'
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