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R~pR CITY VALIDATION <br /> ~e~.ived By: -- <br />Zoning Validation: <br /> <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CEN'I~R Icity Setl~ck <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:O0~m.4:30pm Phone S88-S147 <br /> .,~ ~.~__~ Froot: Re. ac <br /> <br /> 24 hr. Imlk~floa Line ~8-7904 <br /> Left Side: Right side: <br /> FAX .68g-794~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH-4- ~-- ~.~'~/~-~4~ 'f~ ~.~ -- <br />1. JOB DESCRIPTION -' 5~/~' ~'~'-~J ~ <br /> <br /> RESIDENTIAL COMMERCIAL Use of Slmcture: <br /> (}~)Additlon ( )Relocation ( )Addition ( )New <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> ( )Accessory ( ) Change of Occupancy ( )Other <br /> <br />Desmipfi~,ofWork [ Isflfisahistorlcnlbuildlng? Yes - ~ <br />SquamFootage-Basement: IMainFl°°r: ~'~~ I I°=": I: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Business Name <br /> <br />P.~gistratioa No. <br /> <br />4. FEE SCHEDULE <br /> <br />I hereby certify that the above iofonnation is correct. <br /> <br /> (2) lnvesfiptioa F~. <br /> <br /> (3) Reinsl~cfion Fee ~ <br /> <br /> (4) Oiher l~sl~lioas aa~ listed above <br /> <br />RECEIPT: <br /> <br />Permits are non-transferrable and expire if work is not sta~ed within lg0 days of isSUance or if Fork is Suspended for 180 d~ys. <br /> <br />Name of Applicant (Please Print): <br /> 15-73 Rev 1/95 <br /> <br />Date: <br /> <br />=$ <br /> <br />TOTAL . $ <br /> <br /> <br />