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IFOR CITY VALIDATION <br /> <br />Zoning Validation: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />i. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DBV~LOPM~NT C~NT~R <br /> <br /> Ip FOR CITY USE ONLY <br /> s.oo.=.4ao <br /> <br />BUILDING <br /> <br />()Addition ( )Relocation ()Addition <br />( ) Alteration ( ) O~er ( ) Alteration ( ) Sign <br />(~cccsso~ ( )Ch~ofOccupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION fi)YE q '?~ '7 ! <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( Off' I am a CONTRACTOR registered with the St;~ of Oregon, <br /> <br /> ( ) lamanAUTHORIZEDREPRF~ENTATIVEofthepmp~yown~rOrconm~tor,7~ . <br /> Name <br /> <br /> Mailing Addm*s Phone <br /> <br />4, FEE SCHEDULE <br /> <br />A. <br /> <br />VALUATION (See "Valuation Schedule" to determine valuation bas~cl <br />On $qual~ footage of project.) Valuation: $ .~2~/~.~, ~ <br /> <br />(I) Pgrmit Fee <br /> <br />(2) 5% g~at~ Sur~barg¢ 605 x At) <br /> <br />(3) Stmcturai Plan I/evi,w (.65% x Al) <br /> <br />(5) Zoning Surcharge. if applicable (.05% x A I ) <br /> <br /> =S <br /> <br />TOTAL =$ r~.l, 3~Z/~ <br /> <br />Permits are non-transferrable and expire if work is not stalled within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Prj41t): <br /> <br />MC 15-73 Rev 1/05~ <br /> <br /> <br />