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I~OR CITY VALIDATION <br /> JReceived By: __ <br />. ning'Validation: I <br />IDate: <br /> I <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 58~-5147 <br /> 24 hr. lnspn~ion Line S88-7904 <br /> FAX 588-794~ <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 Use of SIxucture: <br />( ) Addition ( ) Relocation ( ) Addition ( ) New <br />( ) Alteration ( ) Other ( ) Alteration ~$ign <br />( ) Accessory ( ) Change of Occupancy ( ) Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />PdvateWell ( ) spfiag ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />on square feotage of project,) Vnioathm: $ ~ <br />(1) Permit Fee <br /> <br />(2) 5% State Surcharge (.05 x Al) = <br />(3) Structural Plan Review (.65% x Al) = <br />(4) Fire & Life Safety Plan Review (.40% x Al) - <br />(5) Zoning Surcharge, if applicable (.05% X Al) - <br />(6) Seismic Surcharge = <br /> <br />TOTAL <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br /> <br />Permits are non-~ransferrable and expire if work is not started widiin 180 days of issuance or if work is suspend~fffor 180 days.~ <br /> <br /> <br />