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FOR CITY VALIDATION ] <br />l~ceived'By: __ I <br />Zoning Validation: <br /> <br />Date: <br /> <br />COMPL~'I'k; ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00mn-,l:3Opm Phone 588.5147 <br /> 24 hr. laqnction Line S88-7904 <br /> FAX $88.7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br /> FOR CITY USE ONLY <br /> <br />Oty Setback Requitemems: <br /> <br />1. ,lOB DESCRIPTION <br /> <br /> RP'SIDENTIAL COMMERCIAL Use of 5~ru~ure: <br /> ( ) Addition ( ) Relocation ( ) Addition ( ) New <br /> ( )Alto-ration ~Other ( )Alteration ( )Sign <br /> ( )Accesso~T ( )ChangeofOccupancy ( )Other <br /> ~] No. Stofi~sl~., ~4,~ ] [sthis ahistorlcal b~i[ding? Yes - No <br />EnetgyDeS~P6°n of WO~kpath: . ~'~f'rv-~ I No. or £mploye, es: ~x,sd~g - New - I No. Sedmoms: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> Mailing Address II}one <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />- -': : r-::-..z,.-j ) v.l,.lio~:S-----t t ~'-- <br />(I) Permit Fee <br /> <br /> (3) S~ PI~ ~view (.65% x Al) <br /> <br /> (4) ~ & Life S~ety PI~ ~ew (.40% x Al) <br /> <br /> (5) ~ing 5u~ge, ff appUcable ¢5% x Al) <br /> <br />TOTAL <br /> <br />=$ <br /> <br />=$ <br /> <br />I hereby c~-rtify tl~t the abo~e information is correct. <br />Permits are non.transferrable and expire if work is not strand within I g0 days of issuance or if work is suspended for 180 days. <br /> <br />MC 15-73 Rev 1/95 <br /> <br />Date: <br /> <br /> <br />