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FOR CITY VALIDATION I MARION COUNTY BUILDING INSPECTION <br /> Received By.' 285 Church St. NE - Room 132 <br /> 7 ~l~~~ Salem, Oregon 97301 <br /> Validation: <br />Iz~°nmg I 8:00am.4:30pm Phone S88-5147 <br /> <br /> .... I FAX 588-7948 <br /> <br /> BUILDING PERIVIIT APPLICATION <br />COMPLETE ^LL SECT,ONS,, T" OUO. 4 , Ill ffIV£1l <br />1. JOB DESCRIPTION ~Z ~-~'"1~'~~''' <br /> <br />FOR CITY USE ONLY <br /> <br />mm~rn^[ co~ma~ "~ ..... u. of s.i6i': 6 <br /> ( )Addition ( )Relocation ()Addition ()New a~Bl0N <br /> ( ) Altem0on (~ O~er ( ) Alteration ( ) Sign BUILDING ~ECTION <br /> ( )A~esso~ ~q~ ~O0r. < >ChangeofOccupancy ( )O~er <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> 1 ara th~ PROPERTY OWNER and own. reside in, or will reside in the compl~exl structur~ and will be my own ganexal contractor. I undo'stand that I must register as a conatrucnlon <br /> contractor ff the structure is sold or offered for sale before or upon completion. If I him subcontractors, I will hire only subcontrac~rs regLstered with the Conslructlon Contractors Boar~L <br /> <br />4. FEE SCHEDULE <br /> <br />on squar~ footage of project.) <br />(1) Perrait Fee <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) S~mcraral Plan Review (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan Review (.40% x Al) <br /> <br />Il. 3g <br /> <br />(2) Investigation Fee <br /> <br />(3) Reinspoction ~ @ $25.00 <br /> <br />(4) Other Insp~c_ t/oas not listed above <br /> <br />TOTAL <br /> <br />=$ <br /> <br />I hereby certify ~hat the above information is correct. <br />Pern'fits are non-a'ans ferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br /> <br />