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[FOR CITY VALIDATION <br />ReceivedBy: ~ ~ ~ <br />Zonia~g Validation: 'g ~',~'.~''. <br />ID=: <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY I <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St. NE - Room 132 City Setback Requirements: <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 Front: /~) I Rear:. l~l~ I <br /> 24 HR Inspection Line 588-7904 Lea Side:~'~'/~t Right Side: /.~- t <br /> FAX .~8-79'88 <br /> <br />1. JOB DESCRIPTION <br /> <br /> ( ..'~ew Placement Garag~e or ~..~_.~ I.'.'J' ~ "~ 1996 <br /> ( )Replacement (,.'~ttached UtTi~}~10N ~00N~t' <br /> ( ) Additional Unit Add-on ( ) Oetached . B I. LIINP. !.~j ;n,-_£ <br /> <br />S~me: /.t'~vy Ye=of No. of L~.gth , - CF~liflON <br /> Manufacturer 9 ~ Sections ,2--- '~'~-' ~- ~ <br />Type of Siding: TYPe of Roofing: Square Footage: ,/~t./~ p 'No. of Bedrooms: ,.~ <br />( ,,'3W~Cood ( ~/'~omp <br />( ) Metal ( ) Steel Pit Set: Energy: <br />( )Vinyl ( )Metal ,~ p / ~ <br /> <br />2. LOCATION OF INSTALLATION_ _. <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in thc complet~i structure and will be my own general contractor. I understand that I <br />must register as a consmiction con~ractor if the structure is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire only <br />subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor who is registered with the <br />Construction Contractors Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />( ) I am a CONTRACTOR regismred with the Stat~ of Oregon. <br /> <br />() <br /> <br />Phone: <br /> <br />~ooe: 7/.F~7 7 gt/ <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufactured Placement/Connections <br /> (includes EL, PL, ME connections) <br /> State Surcharge <br /> State Fee <br /> <br /> TOTAL <br /> <br />$245.00: ~1~¢~ <br /> <br />$n.2~ = 1,1.,,1 $" ( <br />$2o.oo: ..a~. t~ <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Reinspection Fee <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br />NAME OF APPLICANT (please lxin~~/,~/~_/.7'1~ ~--~~--~~'~--'~ ~ '~ <br /> <br />MC 15-64 Rev 3i95 <br /> <br /> <br />