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FOR CITY VA~LIDA,TION <br />ffeceive~y: .~/~ <br />Zoning Validation: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> $:00am4:30pm Phone $88-$14'/ <br /> 24 hr. lu~peeflon Line $88-7904 <br /> FAX 588-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />FOR CITY USE ONLY <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL COMMERCIAL U~e of Struclure: <br />( ~Addition ()Relocation ( )~d~io~ <br />( ) ~terafion ( ) ~er ( ) Alteration ( ) Si~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THJg WORK <br /> () <br /> <br />I am an AUTHORIZED REPRESENTATIVE of th~ property owner or contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. VALUATION (See "Valuation Schedule" to d~t~nnine valuation b~s,:d <br /> <br />on square footage of project.) <br />( I ) Permit F~ <br /> <br />(2) 5% State Surcharge (,05 x Al) <br /> <br />(3) S~uctural Plan Review (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan R~vJew (.40% <br /> <br />(5) ~.,.::..~,: ...l._ o, i' ~Tpli, <br /> <br />(6) Seismic Surcharge <br /> <br />RECEIPT: <br /> <br />TOTAL .$ 7J, .~ <br /> <br />I hereby certify that the above information is correct, <br />Permits axe non-~rans ferrable and expire if work is not stared within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Signature of Applicant: Date: <br />MC 15-73 Rev 1/95 <br /> <br /> <br />