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FOR. OFFI.CE USE ONLY <br /> Rece~v?d by:~ <br /> Zoning Validation: ~ <br />I Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br />Salem; OR 97301 <br />g:00 am-4:3Opm Phonc 55g-5147 <br /> <br />MANUFACTURED <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1, Job <br />Rcside~t~al(/~ <br />Commemial( ) New( ) <br /> <br />E ONLY <br /> <br />L¢fft Side: Pdght Side: <br /> <br />Color of <br /> <br /> , Footage: <br /> <br /> Oaragc <br />COUNTy ( ) Vv[a0hed <br /> <br />2. Location <br /> <br />.... Subdivls~ ~ I Blmk Urban Growth Bounda~? <br /> <br /> 3. Contractor Information . <br /> <br /> ( ~ I wi~ ~ my own gmc~ ~nt raaor, <br /> <br /> ~ I him su~ntmao~, 1 wffi ~ only subc~t~to~ mgiste~ wi~ ~e C~s~alon C~ac~ Bmr, <br /> <br /> ~ed~y no~y Ma~ <br /> <br /> A, (I) Man~a~umd Hmo ; ' <br /> <br /> (3) State Sushi= <br /> (4) ' . ' ) ~ D. ~vesfiga~ Fee ~ _ <br /> <br /> I ' , ~ 40,~ ~r hour (2 h~r ~m) <br /> g. ( ) ~g. dStmem~SmmgcFee <br /> (2) ~g.'dSmctu~Sm~geR~w~ ~ $25.~=~ 1,:~ <br /> <br /> RECE[~; <br /> <br />Name of App~cant (ploaso pnnt): ~ ~ / ~,l~ Phone: <br />MC 15-64 Rev 11-91 <br /> <br /> <br />