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MARION COUNTY BUILDING INSPECTION <br /> <br /> ~lem, OR 97301 <br /> 8:00sm - 4'.300m Fb3ee 58~-$ t47 <br /> FAX $88-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br />COMPL~TB ~ SECTIONS, 1 THROUGH 4 q Q'"' <br />1. Job Description ~/mY <br />RI~qlD~NTIAL <br />(~A) Addition <br />( ) ~uma,i~e <br />( ) Acce.,e,~ <br /> <br />2. Location or Installmion <br /> <br />Subdivimim <br /> <br />Mai~s A~h~ <br /> <br />MoMle Heine Pa.-k <br /> <br />Lo~ Wi~h <br /> <br />T~ A~t. No. <br /> <br />Si~ No. <br /> <br />La~ <br /> <br />Sl~c~ # <br /> <br />Wmr Sul,pl~: <br />Private Well ) Sf~in{ ( ) <br />C. ommunity Wen ( ) a~ ( ) <br /> <br />3. Con.actor Information <br />In, n,~,w O,~e~ IMtUi~ Add.e-- <br /> ( ) Iowu, m~i~in,~w~l~iu~hmcompleted~. <br /> <br /> ( ) Itmdmm~ltl~tlmu~i~m. asac~muu~imcamnct~ff~'~m~muui,~oldcr~~~m. <br /> <br /> ( ) Iwillb~myovm$m~mlcmuso~. <br /> <br /> <br />