Laserfiche WebLink
- FO~ CITY VALIDATION I MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br /> . ' /9 · =~ ~ ~ ] COMMUNITy DEVELOPMENT CENTER <br /> Re,.~?ived By: ~ ~ 285 Church St. NE - Room 132 Ici, Sethack Req~firements: <br /> -- ~ ' . . ~, [ ./ Salem oregon97301 c'~ ~---. 1 <br /> ZomngValldatm~m ,)t"' I 8:00am-4:30pmPhoneS88-5147 I~)}}_~.a~"a{~.,~~.~t [Rear: <br /> IDate: S t~--e/"~ ] 24 HR lnspeetion Line 588.7904 I ohtSJde. <br /> ~ FAX 588-7948 II~l r,.," <br /> <br /> COMPLETE <br /> ALL SECTIONS, 1 THROUGH 4 APPLICATION <br /> <br /> 1. JOB DESCRIPTION ~.~RlO~J OOUNT¥ ~',~'-.~.~.,~ <br /> <br />(~ New Placement Garage or Carport <br />( ) R~lacement ( ) Attached <br />( ) Ad~6o~l U~t A~-on ( ) De~ched <br />Oeale~ Ye~of <br />N~e: M<ufac~r Sections <br />Type of Sidi~: Type of R~fing: <br />~ Wo~ ( ) Comp Squa~ F~tage: <br /> Me~ ( ) Steel Pit Set: <br />( )Vinyl (~Metal <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> JfiT ]~ilingAddress <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE 1VHO IS DOING THE WORK <br />~ 1 am the PROPERTY OWNER and own, reside in, or will reside ia the completed structure dud will be my own general contractor. I understand that I <br /> <br />Mailing Adth~ss: Phone: <br />I am an AUTHOR[ZED REPRESENTATIVE of the property owner or the contractor. <br /> <br />Mailing Address: Phone: <br /> <br />4. FEE SCHEDULE <br /> <br />A. ManuthctaredPlacement/Connecilons $245.00: Oq ~,OO B. Additional Inspection/ <br />(includes EL, PL, ME conr~ctions) Coeyond third inspection) <br />Stat~Su~chra~ $12.25 = [ ~ ~ ~ ReinspectionFee $60.00 = <br />Stat~ Fe~ $20,00 = <br />Zon~g Sure]large (if applicable) $20.00 - <br /> <br />I hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance <br />or if work is suspended for 180 days. <br /> <br /> ' <br />NAME OF APPLICANT (please lmnt) .PHONE (.503) '-'q]/-~'13 <br />$IGNATU]LE OF APPLICANT: __DATE: '~ q ~'~ <br /> · / -I <br />MC 15-64 Rev3/95 <br /> <br /> <br />