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FOR,CITY VALIDATION! <br />l~.aeived~By: ~ ( <br />Zoning Validation: ~N~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:OOam-A:3Opm Phone 588-5147 <br /> <br />24 hr. Impeetion Line .~&7904 <br /> <br /> APR 2 3 1996 <br /> <br />FOR CITY USE ONLY <br /> <br />RESIDENTIAL <br />( ) Addition ( ) Relocation <br />( ) Alteration ( ) Other <br />'~ Accessory <br /> <br />Squa~ Footage -Basement:. [ Main Floor: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Mobile Hom~ P~rk . <br /> <br />COS~m~CL~ MARION COUNTY <br />( )A~.o. BUILDING INSPECTION <br />( ) Alt~on ( ) Sign <br /> <br /> ( ) Change of Occupancy ( ) Other <br /> <br />Use of Structure: <br /> <br />INo. of Employees: Existing - New - I No. <br /> <br />Block <br /> <br />W~t~' Supply: <br />IMvat~Well ( ) Spring ( ) <br />Community W~II ( ) City "~ <br /> <br />3. CONTRACTOR INFORIVIATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />( ) I am tl~ PROI~ERTY OWNER snd own, reside in, or will reside in the completed structure and will be my own general ~ontractor. ! understand that I must ~giater ~s a ~onsln~tion <br />contractor if the s~mctum ia sold or offea~d for sale before or upon completion. If [ hire subcontractors, I will hire only subcontrac~tora registered with th~ Coustn~ion Contractot~ Board. <br />If I change my mimi and do hLre a general contractor who is regiatered with the Conatmcfion Contractors Board, I will immedintely notify Marion County of the name of the contractor. <br />( ) I nm a CONTRACTOR regiatered with the Start of Oregon. <br />( ) I$m ~n &UTHORIZED REPRI~$F,I%FrA~ of the propetqt owner or contractor. <br />Name <br /> <br />4. FEE SCHEDULE <br />A. <br /> <br />VALUATION (~ "Vnluafion S~h~dul~' to determine valuation based <br />on aquar~ footage of project.) Valuation: $ ~ <br /> <br />(1) Permit ~ <br /> <br />(2) S~ Sine Surdm~ COS x <br /> <br />(3) Stmgtunl M l~view (.65% x Al) <br /> <br />(4) Fir~ & Life Saf~y Plan Review (.40% x Al) <br /> <br />(5) Zoning Surcharge, if applicable (.05% x Al) <br /> <br />(6) Seismic Smcharge <br /> <br />B. Miscellant~us (1) Additional ~ Reviews or Addendun~ <br /> <br /> (2) Investigation Fee <br /> <br /> (3) Reinspection Fee ~ <br /> <br />=$ <br /> <br />I hereby ce~ify that the above information is con~:t. <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 />SiglmtumofApplieant: ~~_ ~O~'~ Date: ~' <br />MC 15 73 Rev 1/95 ~ <br /> <br /> <br />