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FOR CITY VALIDA~i2ION ] <br /> <br />Zoning Validation: ~ <br /> I <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 (2aurch St. NE - Room 132 <br /> Salem--301 <br /> <br />BUILDING <br /> <br />Front: /0 t' IR~: /0 ! <br /> <br />1. JOB DESCRIPTION q b' 0~'~ O (~ {D <br /> <br />2~ LOCATION OF INSTALLATION I.~b.z_~ ,t~ L~ ~,9~t_,'s-~ .~_¢.o, <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> () <br /> <br /> Maili.g Address <br /> <br />4. FEE SCHi~,DULE <br /> <br />A. <br /> <br />VALUATION (Se~ "Valuation Schedale" to dvt~nnine valuation b0zed <br />on squa~ fomage of project.) V~luafion: $ ~f'~ <br /> <br />(2) S% ~ts~ Surcharge COS x Al) ~'~5 <br /> <br />(5) Zoning S~charge, ff applicable (.05% x A 1) <br />(6) Seismic Su/charg~ <br /> <br />=$ <br /> <br />I hereby ce~ify that the above information is correct. <br />Permits are non-~mnsfercable and expire ff work is not sta~d within 180 days of issuance or if work is suspended for 180 days. <br />NameofApplicant(Plea~ePt:mt,: t~C ~ k~4~ <br />Signatur~ of Applicant: ~ Date: <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />