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Received By:, <br />IZoning Vafi'dation: ~ I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CEI~i'i~ <br /> 285 Chumh St. NE - Raom 132 <br /> Salem, ~ 973O I <br /> 8:O0mn4:301~a Intone <br /> 24 hr. lmpecflon Line <br /> FAX ~8-794~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />BUILDING ~PLICATION <br /> <br />1. JOB DESCRIPTION <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> contractor ~f the s. tmcm~ is ~ld or offemi for ~ befo~.o~ up~fl comp!efio~ If [ hi~ su. bco_n~to~ I will him only sub~maq~s r~giste~l wiih th~ Comm~ion ~ ~ <br /> <br />MaLling Add~s Phone <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />1 h~reby certify ~hat the above information is .corr~ , <br />Pernuts are non-transferrable and cxpxm f work ts aot started within 180 days o~ ~suanc~ or ff work is su~nd~d for I ~0 days, <br /> <br />Signature of Appllcant: Da~: ~ <br />MC [5-73 Rev 1/95 <br /> <br /> <br />