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Zoning Validation <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am.4:30pm Phone 588-5147 <br /> <br />FOR CITY USE ONLY <br /> <br />2liy Setback RI <br /> <br /> 24 hr. Inspection Line 588-7904 r--~ ,--.~. Side: <br /> FAX588-7948~ ATI~,~(~,jUN '~k'~ ,~ RightSide: <br /> BUII~_4~G PERMIT APPLIC a ~/ <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 ?'T.~ ~ ' ~ ~ ~&"- , <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL COMMERCIAL <br />( ~OAlteration ( ) O~er (~te~fion ( ) Sign <br />( )Accesso~ ( )Ch~geofOecupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />S~fion ~ ( Tow~p ~S ~ge ~ ~ ~ne ~a~ Map W~r Supply: <br />~tWid*~q ~t~p~ a~'~ Ac~s '~g.~t Comer ifa Co~uni~Well () City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br /> () <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />lamaCONTRACTORreglsteredwiththeStamofOregon. '~ Ir')ff~ q/~3 ~' <br /> <br />VALUATION (See "Valuation Schedule" to determine valuation based <br />on squexe footage of project.) <br /> <br />(1) Permit Fern <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />O) Structural Plan Review (.65% x Al) <br /> <br />(4) Fir~ & Life Safety Plan Review (.40% x Al) <br /> <br />B, Miscellaneous Fees <br /> (I) Additional Plan Reviews or Addendums <br /> (2) Investigation Fee <br /> (3) Relaspeetion Fee @ $25.00 <br /> (4) Other lns~ctlons not listed above <br /> <br />=$ <br /> <br />TOTAL <br /> <br />I hereby certify that the above information is correct. <br />Permits a~ non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br />Name of Applicant (Please Prim): ~ ~"/'~ ~ tt-~.~ ~'~? ~ Phone: <br /> <br />Signature of Applicant: c~.44M~ ~ ~ ~/ Date: <br /> L/ <br />MC 15-73 Rev 1195 <br /> <br /> <br />