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FOR CITY VAL ,IDeaTION <br />[Received By: <br />IZoni'fig Validation: ,_ <br /> <br />COMPL~i'I: ALL SECTIONS, 1 THROUGH 4 <br />1. ,IOB DESCRIFHON <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPM~IT C-I~¢I~.,R <br /> 285 Church St. NE - Room 132 <br /> Salem, Or~ <br /> <br /> ~ hr. I~l~ou Line ~$~-?~ FAX <br /> <br /> BUILDING PEILMIT APPLICATION <br /> <br /> FOR CITY USE ONLY <br /> <br />City ~tback P. equ~m~nm: <br /> <br /> RESIDENTIAL COMMERCIAL Ug <br /> ()Addition ( ) P,~location ( ) Afidition ()New <br /> ~Alteration ( )Other ~ )Alteration ( )Sign <br /> ( ) Accessory ( ) Chang~ of O~cupan~y ( ) Other <br /> ' . <br />D~s~ipti~nofW~rk OO" t / ' ~.. ' ' Isthiaahistoricalbuil~ing? Yes o <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Subdivision Lot ] Blo~ <br /> Priv$1~W~l ( ) gl~ing ( ) <br /> <br />3. CONTRACTOR I~FORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Mailing Address ~ <br /> <br />4. FEE SCHEDULE <br /> <br />:A. <br /> <br />=$ <br /> <br />I hereby certify that the above information is ¢orrect. <br />P~mits a~ no~-transfermbl~ ~ expire if~k is not star~/e~/~in 150 days of isax~a~c~ or if w.k ia sus. n~ for 1~ ~ys. <br /> <br /> <br />