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CITY VALIDATION <br />ZoningValidafion: v - /j,~ I <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> Salem, Ore <br /> <br /> nx JUN <br /> BUILDING PERMIT API'~I~CA~31~96 ~ <br /> ¢OU 6y <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Reqairemen~s: <br /> <br />,~t: /O t Rw: /0 / <br />ftSid~: RightSide: //9 t <br /> <br />I. JOB DEsCm~TION q ~,_ ~ .~ ~ ~ BUll. DING INSpF. OTION <br /> <br />RESIDENTIAL COMMERCIAL Use off Structure: <br />(v~dflltion ( ) Relocation ( ) Addition ( ) New <br />( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br />( )Accessory ( )ChangeofOccupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I ara the PROPERTY OWbUER and own, resibe ia, or will n~sid~ in th~ comple~l structure ~d witl be my own g~neral coaffaetor. I under, and that I must register as a construction <br /> ~onu'aeun if th~ structure is sold or offered for sale before or upon ~ompl¢fion. ff I hi~ subcoatcmctors, I wU] ~re only subcontractors mgistar~d with the ConsU~efion Contractors Board. <br /> <br />Registration No. <br /> <br />4. FEE SCHEDULE <br /> <br />on sqtmm footage of project.) <br /> <br />(1) l~rralt Fee <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) sm~etoral Plan p~a~w (.65% x Al) <br /> <br />(4) Fire & Life Safety plan Reviaw (.40% x Al) <br />(5) Zoning Surcharge. if applicable (.05% x A 1 ) <br />(6) Seismic Surchatg~ <br /> <br />(1) Additional PIa~ Reviews or Addendums <br /> <br />(2) Investigation Fee <br /> <br />(3) R~inspecfion Fe~ @ $25.00 <br /> <br />(4) Oth~ Inspections not listed abow <br /> <br />=$ <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 />Nam~ of Applicant (Please Prim,:C"'"~K"~ *~-...'__ ~ ~-~ ~ ~/1~ ~ Phone'. <br />Sign~tere of Applicant: ~~*~ ~ Date: <br /> <br />MC I5-73 Rev Ln)5 <br /> <br /> <br />