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I~OR CITY VALIDATION] MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />I ~ /i · f 1 ' ~ COMMUNITY DEVELOPMENT CENTER <br /> Received By ~' 285 Church St. NE - Room 132 <br /> City Sethack Requirement s: <br /> <br /> Zoning Validation: .~ I 8:00am-4:30pm Phone 588-5147 Front: I Rear: <br /> <br /> Date: q-I t~ ~./(o ] 24 HR Inspection Line 588-7904 ~~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br /> 1. JOB DESCRIPTION <br /> <br /> ) Replacement <br /> ) Additional Unit Add-on <br /> <br /> Dealers ~b4J~B~"L.L- <br /> Name: 4~ Oi, t4 ~F~ <br /> <br /> Type~f Siding: <br /> ( ~'9 Wood <br /> ) Metal <br /> ) Vinyl <br /> <br /> FAX 588-7948 <br /> I~IANUFACTURED DWI~'~ ~ ~ ~ <br /> _~PER~ ~APPLICAT <br />_~ ( ~ <br />~n~fac~r lq 7 Sb~ti~fns <br /> <br />Typeo Roofing: <br />(~mp Square Footage: / ~}.,~-.~.~ No. of Bedrooms: <br />) Steel Pit Set: Energy: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Urb~Gmwth Bound 9~ Supply: { ) Private WcH ( ) Community Well ( ~ty <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I ma the PROPERTY OWNER and own, reside in, or will reside in the completed stracture and will be my own general contraOor. 1 understand that I <br />must register as a consh'uction contractor [1' tbe structure is sold or offered for sale befon~ or upon completion. If I hire subcontractors, 1 will hLre only <br />subcontractors registered with the Construction Contractors Board. If 1 change my mind and do hire a general contractor who is registered with the <br />Conslracfion Contractors Board, I will inunediately notify Marion County of the name of the contractor. <br /> <br />I am a CONTRACTOR registe~d with the State of Oregon. <br /> Business Namg: . Registration No.: fg~40 <br /> <br />(~"/ I am an AUTHORIZED REPRESENTATIVE o f the properOj owner or the contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />B. Additional Inspection/ <br /> (beyond third inspection) <br /> Ralnspection Fee <br /> <br />$60.00 - <br /> <br />1 hereby certify that the above information is correct. Permits am 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 />MC 15-64 Rev3/95 <br /> <br /> <br />