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FOR CITY VALIDATION <br />[R~c~'ived By: ~f'~.~ <br />[Zo~ng ,Vali~tion: ~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St, NE - Reom 132 <br /> Salem, Oregon 97301 <br /> 8:0~am-4:3Opm l~n one ~88-~147 <br /> 24 hr. Imueclfon.12ne~,~,-~ ~ <br /> <br />JFOR CITY USE ONLY <br /> <br /> If' <br /> <br /> RESIDENTIAL COMIvlERCIAL MARION COUNTY <br /> ~Addition ( ) Relocation ( ) Additi .... NG <br /> ( )Alteration ()Other ( )^~r~nUILU INSPEcC?~( )Si,n <br /> ( )Accessory ( )ChangeofOccupancy ( )Other <br />DescfiptlonofWork ] lsthisaMsto~call~ildlng? Yes ,~ <br /> <br />LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO I$ DOING THE WORK <br /> ( ) <br /> <br />1 am an AUTHORIZED REPRESENTATIVE of the property owner or contrac~3r. <br /> <br />4. FEE SCHEDULE <br /> <br />(2) Inv~ipfion <br /> <br />(3) Rein~pectlon Fee O <br /> <br />I hereby cetrify that the above information is correcL <br />Perm/ts are non-transferrable and expire if work is not started within 180 days of issuance er if Work is suspended for 180 days. <br />Name o f Applican, (Please~ ~ ~t~ Phone: <br />Signature of Applicant: C ~ Da~: <br />MC 15-73 Rev 1/95 <br /> <br /> lqr <br />/ / <br /> <br /> <br />