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FOR CITY VALIDATION <br />Received By: /~~c/~ <br />Zoning Validation: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEV ELOPI~.Jcr <br /> 285 Chu~h Sc NE - Room 132 <br /> Salem, Omjoa 97301 <br /> 8:0eem-4::~lm~ etmee S~-$14T <br /> <br /> FAX <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL <br /> <br /> ( ) Addition ( ) Relocation <br /> ( ) Alteration ( ) Other <br /> ( ) Accessory <br /> <br />FOR CITY USE ONLY [ <br /> <br />COMMERCIAI~'~'V 2 6 Isg~ <br /> Addition , ( ~JNew <br /> )^~m.a~RION C0UR!t( )sis,, <br /> ( ) c'~,l~g~Gd~ P E C TIO N O~' <br /> <br /> New - ] No. ~: <br /> <br />Um oLSmmm~: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />I hereby ca. fy that the above information is concet. <br />Penmt~ are nmi-frans femlble and expire if work is not started within 180 days of issunn~ m- if work is su qx. ~ i'm 180 days. <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />