Laserfiche WebLink
FOR CITY VALIDATION <br />IReceived By: __ <br /> <br />]Z~ning Validation: <br /> <br />[Date: <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 /> 24 hr. Inspection Line 588.7904 <br /> FAX g88-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL <br /> ) Addition <br /> <br /> ( ) Alteration <br /> <br /> ( ) Accessory <br /> <br />) Relocation <br />) O&er <br /> <br />COMMERCIAL <br /> <br /> ( ) Addition ( ) New <br /> ( ) Alteration ( ) Sign <br /> ( )Chang¢ofOccupancy ( )Other <br /> <br />Description of Work <br />Energy Path: /_ No. Stories ,,,, t No. of E~nployeea: Existing.vNo. Stories No. of Fauployee~: Existing - <br /> <br /> LOCATION INST LAT O <br /> <br />Subdlvi~ion ~ ~ <br />--Secfi°" I~ Township Range ~ Zone ~ __~ Map }~.. ~ <br /> <br />Is this a historical building? Yes ~ <br /> IOther:[ N°' B~dr°°ms: ~Height: <br /> <br />Tax Acct. No. <br /> <br />p.o.eNo I 7 7-/ <br />pho.eNo. I--7 <br /> <br />Block <br /> <br />Water Supply: <br />Private Well ~ Spring ( ) <br />C0mmunityWel! ( ) City ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />VALUATION (Se~ "Valuation Schedale" to d~tennlne valuation based <br /> <br />on square footage of project.) Valuation: $ <br />(I) Permit Fee <br />(2) 5% S~ate Surcharg~ (.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, ff applicable (.05% x Al) <br />(6) Seismic Surcharge <br /> <br />TOTAL = $ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if wor~ not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Apptieant (Please Print): {i ~_, ~ _.Phone: __ <br /> <br /> <br />