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FOR CITY VALIDATION <br />IYeceived'By: ~_ <br />Zoning Validation: _~_~ <br />Date: ~_/~. ~5~ <br /> <br /> MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 ChurChsalem~St.o~t~zy_~0j._~NE - Roolll 132 [City Setbagk Requjmm~ms; <br /> 8:00am-4:30~,~?~1~ ~'~ ~'~' 5T~ ~ r~. Front: /Or ]Re~: /0.2 ... <br /> <br /> BUILDING PEmlT g~LmATmN~J)~] <br />COMPLETE ALL SECTION~ 1 ~ROUG~4 ~ /,~ ~ ~ <br /> ~ASIO~ COUnTy <br />1. JOB DESCRIPTION BUll D!~jC ~/~ <br /> <br />RESIDENTIAL COMMERCIAL .... ~t t,O~.O /0~se of Structure: <br />( ) Addition ( ) Relocation ( ) Anal:ion ( ) New /~ ~ ~ <br />( ) Alteration ( ) Offier ( ) Alto~tion ( ) Sign <br />(~ccesso~ ( ) Ch~ge of Occup~ey ( ) O~er <br /> <br />2. LOCATION OF INSTALLATION 3',[ ,~£m£tJd/~ [J~' q I S~ Yf- <br /> <br />~tWId~ ~/ ~tDepfl,,,,,~; ............. ~va~Well ( ) Spring <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am a CONTRACTOR registe~ with th~ gtat~ of Oregon, <br /> <br />4. FEE SCHEDULE <br /> <br />A. VALUATION ($~ "Valuation geh~ha~" to determine val0atlon <br /> <br /> on squ~ec footag~ of project.) Valuation: $ <br /> <br />(1) P,trait Pee <br /> <br />(2) 593 Stllt¢ Surcharge 605 x Al) <br /> <br />(3) Structural Plan Reviow 665% x Al) <br /> <br />(5) Zoni,g $umharge. if applicable (.05% x Al) <br />(6) Seismic gun;harge <br /> <br />(1) Addiaonz] Pla~ Rev~e~'s or Add~ndums <br />(2) Investigation F~ <br /> <br />TOTAL =$ ~-o'~ <br /> <br /> hereby cerlit~ that thc above inl~rmatlon is ¢o/~ct. <br /> <br />MC 15-73 Rev 1/93 <br /> <br />7~'~'- 77d <br /> <br /> <br />