Laserfiche WebLink
F?R CITY USE ONLY <br />Received By: /~ <br />Zoning V. alidation: ~ <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 /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br />FOR CITY USE ONLY <br /> <br />DEMOLITION PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. JOB DESCRIPTION ~ttus a tustoncal bufldln <br /> RESIDENTIAL ( ) OR COMMERCIAL (~ I - ' .... g~,~? ]VO <br /> USE OF STRUCrU~: ~'e~ O ) ~<: ~'/'~7'/i o,tf ~ "- <br /> <br />SQUARE FEET Basement: 1 Main Floor: I Second Floor: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Property Owner ~al~n t]~.~S, < ,¥~,~ ~ I MailingAddress,~O/~/~O.~ '-'7 ..... ' PhoneNo. <br /> <br />S~tion ~ Township ~ R~ge ~ ~ne.' ~ 'EZ hap~~ Wmer Supply: <br /> ' Private Well ( ) Spring <br />~t Width ~ ~t~p~ Z~ Acr~ ~/~ l~g. Lot ~/~ Comer ~ Community Well ()Ci~ ((~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />1 am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I must vegister as a constracdon <br /> <br />I am a CONTRACTOR registered with the State of Oregon. <br /> <br /> (please pnnt) V <br /> <br />I am an AUTHORIZED REPRESENTATIVE of the prop~iy ova~r or thc conlracior. <br /> <br /> (please print) <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> <br /> (minimum $2,000) <br /> <br />(See Table No. 3-A) <br /> <br />B. PERMIT FEES <br />t. Demolition Fee =$ <br />2. Slate Surcharge (5% x <br /> =s ~-7~ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Print): ,~ W~ ~>~ ~ g <br />Signature o f Applicant .~.~'"~-'"~---~~-~ <br />MC 15-04 Rev 3/95 <br /> <br />Phone: <br /> <br /> <br />