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~I~FO~. ~ITY VALmATION <br /> Received By: __ <br /> Zoning Qalidation: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone g88-$147 <br /> 24 hr. Inspection Line 588-7904 <br /> FAX 598-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br /> FOR CITY USE ONLY I <br /> I <br />ICity Setback R~quitcm~nts: <br /> <br />RESIDENTIAL ' COMMERCIAL /t~ ~/]~,.~ UseofStmcmre: <br />( )A~itlon ( )Rel~afion ( )Addition (~N~w ~~~ ~ <br />( )Alteration ( )~ ( )Alteration ( )Sign ~ <br />( )A~sso~ ( )Ch~geofOccupancy ( )O~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Tax Acct. No. &JO <br /> <br />cross s'i~ ~,,'o oo <br /> <br />Subdivision Block <br />Mobile Home Park <br /> <br />Lot Dqnh <br /> <br />Range <br /> <br />Lot Width <br /> <br />Water Supply: <br />FrivamWeU (/.-)~ Spring ( ) <br />Commu~ty Well ( ) City ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am the PROPERTY OWNER and own, reside in, or will r¢~d¢ in the completed stmctur~ and will be my own g~n~al contractor. I understand that I must register aa a construction <br /> <br /> Marling Address/.. pi-, ~-. tOO Do <br /> <br />4. FEE SCHEDULE <br />A. <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expke if work is not started witNn 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Print): ]'~O~.t~O~t~ IO~lle'l~- ~one: <br />Signature of Applicant: NO~. P~.~t~ Date: <br />MC 15-73 Rev 1/95 <br /> <br /> <br />