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IFOR CITY VALIDATION MARION COUNTY BUILDING INSPECTION | FOR CITy USE ONLY <br /> <br /> . - t~ t · Salem, Oregon 97301 ~ ! <br /> Zoning Validation: r ~/~ 8:00am-4:30pm Phone 588-5147/~ ~ [Flont: / 0 / [Rear: J ~ <br /> Data' ~ / ~' / '~ 7 24 HR Inspection Line sas-7~a~'J/_('%~, L,tSide: ,, e-' ]Ri~, Side: ~, <br /> COMPLETE ALL SECTIONS, l THROUGH4 PERMIT APPLICATION *4,0 '~ <br /> <br /> ( V~New Placement Garage o(e~po~-'~f~lN~'~ 0,~, -"~ <br /> ( ) A~ifiO~ Unit A~-on ( ) De~ched ~Cf[~. <br />D~e~~9~ Ye~of No. of ~n~ fO~ Width <br />N~e: ~ M~ufacm~r ~7 S~tioas ~ ~ I ~71 <br /> <br />T~ of Si~ng: Type of R~fing: Squ~e F~ta~: [~ ~ No. of B~oms: ~ <br />) M~ml ( ) Stol ~t Set: ~ ~ergy: <br />)Vinyl ( )Met, NO ~'~'3. <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> Pmp~ Owner: ff ~on¢ NO,: <br /> <br /> Urban Omwth Boundary? ( ) Yes ( ) No { ) Private Well ( ) Community Well ( ) City <br /> <br />:3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO I$ DOING THE WORK <br /> <br /> ( ) I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I u~derstand that I <br /> must register as a construction contractor if the slruetuce is sold or offered for sale before or upon completion. If ! hire subcontractors, I will hire <br /> subcontractors registered with the Construction Contractors Board. If ! change my mind and do him a general contractor who is registered with the <br /> <br />'fn A s: <br /> <br />4. FEE SCHEDULE <br /> <br />A. Manufaetured Placmnt/Connecfions <br /> (includes EL, PL, ME connections) <br /> <br />$~45.oo = ,ZI/,~. ~ B. Additionallnspectiord <br /> (beyond thffd inspection) <br />$12.25 = [~,~ ~'~'~ RelnspectionFee $60.00 = ~ <br />$20.00 = ,~, ~ <br />$2O.O0 = ~ <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 />NAMEOFAPPL[CANT(ple~gpfi3~"~ g~/~ PHONE: '7~f-~/~,/~ <br />SIONATUPJ3OFAPPLICANT: ~,e' ])ATE: <br /> <br />MC 15-64 R~v 3/95 <br /> <br /> <br />