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FOR CITY VALIDATION] <br />Re~e. ived By': ~ <br />Zoning Validation: ' ~ ~!'~/~' ] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room <br /> Salem, Oregon 97301 <br /> 8.-00am-4:30pm Phone 588-5147 <br /> 24 HR Inspection Line 588-7904 <br /> FAX 588-7948 <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. JOB DF_~CRIPTION <br /> ( s"J~w Placement <br /> ( ) Replncement <br /> ( ) Additional Urn? Add-on <br /> <br /> '~WoodSiding: <br /> ( ) Metal <br /> ( ) Vinyl <br /> <br />Year of <br /> <br /> Square Footage: /~-~ No. of Bedrooms: <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requiremems: <br /> <br />~ si~:/_~', ~t si,~: / O ' <br /> <br />PERMIT APPLICATION <br /> <br />Pit Set: <br /> <br />Type of Roofing: <br /> <br />( ) Stee~ <br />( ) Metal <br /> <br />2. LOCAT~,~N O~ ]NSTALLA ~TION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br />() <br /> <br />() <br /> <br />() <br /> <br />I am the PROPERTY OWNER and own, reside in, or will msidc in the completed structure and will be my own general conm~ctor. I understand that I <br />must mgistor as a construction contractor if the stature is sold or offered for ~ale before or upon completion. If I hire subeon~ractors, I ;viii hire only <br />subcon~actors registered wi& the Construction Contrac~rs Board. If I change my mind and do hire a general contractor who is reglstemd with the <br />Conslruction Contractors Board, ! will immediately notify Marion County of the name of the contractor. <br /> <br />I nm a CONTRACTOR registrred with the Stat~ of Oregon. <br />J.~i,~am~: -~ , /. , m,gi~tio~o.: <br /> <br /> I am an AUTHO~.~KD REPRESENTATIVE of the pmpen'y owner or the contractor. <br /> <br /> Mailing <br /> Address: <br /> <br />4. FEE SCHEDULE <br /> <br />B. ^~tion~ n~aio~ <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 /> <br />SIGNATURE OF APPLICANT: .DATE: <br /> <br />MC 15-64 Rev 3/95 <br /> <br /> <br />