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FQ[~-CITY VALIDSTZOn I <br /> ' <br /> <br />Izo ng Validation: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />COMMUNITY DEVELOPMI=.NT CEIq'I'ER <br />285 Chm'ch St. NE - Room 132 <br />Salem, Omgoo 97301 <br /> <br /> 24hr. I <br /> <br />BUH~DING ~) <br /> <br />City setb~k R~qalmueets: <br /> <br />~s~: ~ m~s~: ~ <br /> <br />MARION COUNTY <br /> <br /> ...BU ............. <br />RESIDENTIAL COMMERCIAL ~DING INSPECTI0] <br />()Addition () Relation ~ A~ition : ()New <br />( )~ss~ ( )~geof~cup~cy ( )O~er <br />~on of Work <br /> <br />2. LOCATION OF INSTALLATION q"l'~ ~5 <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am an AUTHORIZED REPRF-~ENTATIV~ of the prop~r~ owner or co~h'a~or. <br /> <br /> ( ) <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />(~) Inv~J~ Fm <br /> <br />(3) Reinspoaion Fm· $.~.00 <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-mmsferrablc and expire if work is not started within 180 days of issuance or if work is SUSl~nded for 180 days. <br /> <br />NameofAppiican,(PleascPrint): ~"~*~"~ a,~,..~sl'~.~dkss~'~ Phone: (~)~ --J4~'4q'4~ <br /> <br />SignaturcofApplicant: -~ '- ~ Da~e: (-~ \[ ~"~ <br />MC 15-73 Rev 1/95 <br /> <br /> <br />