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FQR~IITY VALIDATION MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> <br />[Zomng Vahdauon: . ' ~'~ 8:O~m-4:~OpmPhone$Sg414~t~ <br /> :14 hr. laspeetion L ne <br /> ?7 <br />........... '"" <br />COMPLETE ALL SE~ONS, 1 ~OUGH 4 <br />1. JOB DESC~ION q~l~ <br /> <br /> F-J~:~LuI~ITIAL COMMERCIAL 't~O//[tf.~ <br /> (~ddition ( )Relocation ( )Addition ( )New <br /> Alteration ( ) Other ( ) Alteration ( ) Sign <br /> Accessory ( ) Change of Occupancy ( ) Other <br />Description of Work ] Is this a histodcsl building'? Yes - <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( / I ara n CONTRACTOR ~-gistemd with the Stat* of Oregon. : <br /> <br />4. FEE SCHEDULE <br /> <br />on square footage of project,) <br />(1) Peamit F~ <br /> <br />(2) 5% State Surcharge (,05 x Al) <br /> <br />valuation: S 2{tO~ ~ <br /> / .q.3 <br /> <br />(2) lnv~figotioa Fee <br /> <br />(3) Reinspection Fee ~ $25.00 <br /> <br />(4) Other Ina. j~.ctioas not listed abos~ <br /> <br />aUrAl. -S 7/' <br /> <br /> (5)ZonlngSurehmrgo, ifapplicable(~5%xAI) C~J~y~j- = ~. 7ff <br /> <br />I ~by ce.ify ~m ~e a~ve in.ration is e~t. <br />P~i~ ~ non-U~emble ~ ~xpim if work is not ~ wi~in 180 daym of issu~ee or if w~ im su~ for 180 <br /> <br /> <br />