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)R C~ <br />:eive.~i..By: <br /> <br />ting Validation: <br /> <br />vIPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION ' <br /> COMMUN~'Y DEVELOPMENT CE{qTER <br /> 255 Chinch SI. NE - Room 132 <br /> SmJem, O~egon 97301 <br /> 8:00nm-4t~pm Phone 588-5147 ~t'~ <br /> 24 hr. Im~tlo. Line 588-7~ ~~ ~ <br /> <br />OB DESCRIPTION <br /> <br />~{DEN'T]AL <br /> ( )Addilion a~/. ( ) Relocation <br /> (.)Alteration ~ ( )Olher <br /> ( ) Accessory <br /> <br />COMMERCIAL <br /> ( {~ddition <br /> ( ) Alteration <br /> <br /> ( ) Ch~nse of Occupancy <br /> <br /> 1804 Peppertree Ct. S.E. ~ <br />,OCATION O.F:INSTALLATION <br /> <br />CONTRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />FEE SCHEDULE <br /> <br />TOTAL <br /> <br />.$ <br /> <br />hereby ce~[y Ihl~ the above information is correct. <br />'enaJla ate nomlnmafenabJe ~& ex~i~ ff wink is not s~d wi~Jn 180 day~ o~ issuance or ~f work i~ sus~nd~ for 180 days. <br /> <br />lame of Appiic~t (]Ple.~~ ,, Phone:/~ <br /> <br /> <br />