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FOR CITY VALIDATION <br />:Receivbd By: __ <br /> <br />· Zonin~Validation: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Chumh St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> $:00am.4:30pm Phone $88-5147 <br /> 24 hr. Inspection Line 588-7904 <br /> FAX $88-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />FOR CITY USE~ONLY <br /> <br /> RESIDENTIAL COMMERCIAL Us~ of Structure: <br /> ()Addition ( )Relocation ( )Addition ~{~]ew '~'~.~M~ O~t~ ~l~,~,~Oe~::~ <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> ( )Accessory ( )ChangeofOccupaney ( )Other ~M{-.-~ <br />Description of Work ~ ~ ~g:~ ~lb~.-~ ls this a historical building? Yes-~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Subdlvi~ion Lot Block <br />Mobile Home Park Spac~ # <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) l am the PROPERTY OWNER and own, reside in, or will reside in the completed s~u¢ture and will be my own general coma-actor. I undet~tand that I must register as a constmallc~ <br /> contractor if the structure is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire 0nly subcontractors registered with the Const~ctlon Contraeters Board. <br /> If I change my mind and do hire a general contractor who is r~gtstcred with the Const~ction Contractors Board. I will immedialely notify Marion County of thc narnc of th~ contractor, <br /> <br /> ( ) I am a CONTRACTOR rcgiale~ed with the State of Oregon. <br /> Business Name Registration No, <br /> <br /> Mailing Add.ss Phone <br /> <br /> I am an AUTHORIZED REPRESENTATIVE of the property owncr or contractor. <br /> <br /> Name <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br /> square footage of project.) Valuation: <br />( 1 ) Permit Fee <br /> <br />B. Miscellaneous Fees <br /> (1) Additional Plan Revlaw$ or Addendum~ <br /> (2) Investigation Fee <br /> (3) R~insl~ction <br /> <br />[ hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of is$uance or if work is suspended for 180 days. <br /> <br /> =$ <br />TOTAL = $ <br /> <br /> <br />