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Zoning Validation: <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> ~ 132 <br /> Salem <br /> <br />BUILDING <br /> <br />FOR CITY USE ONLY <br />LcftSide: /~ / RightSid~: f / <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL COMMERCIAL "~ /'/[/C?/~, <br />( ) Addition ( ) Rgl~fio~ ( ) Ad&fion ( ) Nc~ <br />~lterafion ( )O~r ~ltemtion < )Sign <br />( )Accesso~ ( )Ch~geofOccupancy ( )O~er <br /> <br />2. LOCATION OF INSTALLATION ---~'t/- t/.C-"~ ,'-o~, OAg~- <br /> <br />Water Supply: <br /> <br />Community Well ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> 1 ann th~ PROPERTY OWNER and own. malde ~n. or will reside in the completed stracture and will be my own general contractor. I tmderatsmd that I must register as a construction <br /> <br />Phop~ <br /> <br /> () <br /> <br />4. FEE SCHEDULE <br /> <br /> A. VALUATION (Se~ "Valuation Schedule" to deterafine valuation based <br /> <br />Valuation:$ ~ 7 <br /> <br />(2) Investigation Fee <br /> <br />(3) Raln~peetion Fe~ @ $25.~0 <br /> <br />(4) Other Inspections not listed above <br /> <br /> --$ <br /> <br />TOTAL = $ ~ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Print): ~ O'~' a-", ~ -~7 / ~ ~' - '% .Phone: <br />Signature of Applicant: ~~ ~&~ ; Date: ~ <br />MC 15-73 Rev 1/95 <br /> <br /> <br />