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1FORCIYVALIDATION MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER [ ~ -- <br />Ret:el'vadB .,v ~<x ~,. 285 Church St. NE - Room 132 lc ~ Se*~ ~,~.: <br /> <br /> · , , -- ~. .....~e,g~m, Onegon 9730 I ,~ ' J I <br /> ZomngV~_~idfi~ion] L._...~-~,, ~i~'~'~l~n~}0pmPhone588.S14? [Froat:t~O Reain I ~ <br /> <br /> TI NS, ~0 GH ~ <br /> o -0 <br /> <br />LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR/NFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> -~ I am the PROPERTY OWNER and own, reside in, or will reside ~a th~ completed sttuctu~ and will be my own general contractor. I understand that I must register <br /> <br />4. FEE SCHEDULE <br /> <br />3.1.3 <br /> <br />I hereby ceffify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Namo of Applicant (Plea~ Pti~ C)~.~ u ~ ~L,.--/~x-~/ ~ Phone: <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />