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k <br /> <br /> FOR CITY VALIDATION I MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />IR~ce~ved ~y: ~~d~,~ - COM 2MgU5 ChurN1TYc~EstV- ENELO -P RMEI~ IC32ENTER City St~oa~--~ Requi~em~a~---'---~~ <br />I . . I Salem, Oregon 97~ t~;~ ~.. I <br />[Zoning Validation: ~/ t/~t~- I S,00am.4:Z0pmVhoae/S[~"ff/}"O~ea,_ Front: /d t IP'em /d ' <br /> <br /> OUGH4 BUILDING PERMIT APPLI~ <br />COMPLETE ALL SECTIONS, 1 THR /~j~ "'~U ' ~' <br /> BU I0~ , <br />L JOg DESCRIPTION ILDIIVg ;fi ~d ~'~.~'"~ <br /> <br />( ) Addifiol~ ( ) Relocation ( ) Addition ( ) New <br />( ) Alteralion ( )Otl~r ()Alteration ()Sign <br />O~')~Acc~ssory ( ) Change of Occupancy ( ) Other <br /> <br />LOCATION OF INSTALLATION $ $~, ~t. ~O, A~g~¥ ~. <br /> <br />Subdivision Lot Block <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> () <br /> <br />( ~ I am an AUTHORIZ~I~PRE~ENTATI~E of the propemy owner or conuactor. <br /> <br />4. FEE SCHEDULE <br /> <br />=$ <br /> <br />I hur~by certify that the above information is correct. <br />Permits ar~ non-~ansferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />