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FOR CITY VALIDATION I <br />Received By: __ [ <br />Zoning Validation: <br /> <br />Date: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am.4:3Opm Phone~ ~ ~ ~ ~ ~"~ <br /> 24 hr. Inspection Line ~/~ ~ ~1; <br /> <br /> BUILDING PERMIT .al~IltLIC~'fO_N5 19911 <br /> <br /> FOR CITY USE ONLY <br /> <br />City Setback Requis~ment$: <br /> <br />1. JOB DESCRIPTION MARIOk COUNTY <br /> <br />RESIDENTIAL COMMERCIAL ~ u ~ I.u Ill U IV~l~'d~lt[{~e: <br /> <br /> ( ) Ad~tion ( ) Rel~afion ( ) A~tion ( ) New ~ <br /> ( )~fion ' ( )~er ( )Al~afion ( )Sign ~ ~ <br /> (~Accosso~ ( ) C~ of Occup~cy ( ) Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> (~ I am the PROPERTY OWNER and own, reside in, or will reside in the complied structure and will be my own geaeral contr~tor. I undcrstaad that I must register aa a construction <br /> contxactor if the s~mcture is sold or offer~ for sale before or upon compl~tlon. If I hire ~ubcontractors, I w0t hire only subcontractors registered with the Construction Contractors Board. <br /> If I change my mind and do hire a general ecatractor who is mglsterm5 with tbe Constxucfion Contractors Board, I wiU immediately notify Mario~ County of thc name of tho contractor. <br /> <br /> ( ) I am a CONTRACTOR registered with the State of Oregon. <br /> <br />4. FEESCHEDULE <br /> <br />IA. <br /> <br />VALUATION (See "Valuadon Schedule" ~a detenniue valuation based <br />on square footage of project.) <br /> <br />(I) Permit Fee <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) Structural Plan Review (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan Rcvinw (.40% x Al) <br /> <br />(5) Zonthg Surcharge, if applicable (.05% x Al) <br /> <br />(6) Snlsmlc Sttrcha~ge <br /> <br />TOTAL <br /> <br />=$ <br /> <br />I hereby certify that the above information is eon'eot. <br />Permits are non-mmsferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Signature of Applicant: %.~<- ~ ~ Date: <br /> / <br />MC 15-73 R¢v 1/95 ~ <br /> <br /> <br />