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FO.R CITY VALIDATION <br />Zoning Validation: ~ <br />Date: Il.. ~/~. -(~, <br /> <br />COMPLETE ALL SECTIONS, I THROUGH <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Oua~ SL NE - Room 132 <br /> Salem. On:gon 97301 <br /> 8.'00~n-4:~pm Phone <br /> 24 hr. ~ Lin~ <br /> FAX <br /> <br />crr___y usg oNLy <br /> <br />I. JOB DESCRIPTION D~O, ? 3 <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) <br /> <br />FEE SCHEDULE <br /> <br />on squar~ foma~ of ptolect-} Vsh~ioo: S ~ ~ <br />(2) 5% S~ SmO~'~ (.05 x Al) L '~,~ <br /> <br />'ro'r~ .$ 71. ~ <br /> <br />I hereby certify that the above thf~n i~ correct. <br />Pernuts are non-Wans ferrable and mtpim if woct is uet started within 180 days of is$unnc¢ or if Work is suspended for { 80 days. <br /> <br />Signature °f Applicator: ~ Dale: <br /> <br /> <br />