Laserfiche WebLink
FOR CI,TY VALIDATION <br />Received By: __ <br />Zoning Validation: <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 $~.7904 <br /> FAX $8~-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />FOR CITY USE ONLY <br /> <br /> RESIDENTIAL COMMERCIAL Use of Structure: <br /> ()Addition ()Relocation ()Addition ()New (9-0 )~q ~ ~F~---~ ~,~ <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> ( ) Accesso~ ( ) Change of Occupancy ( ) Other <br /> <br />Descdpfion of Work ] Is this a historical building? Yes -~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I ~am an AUTHORIZED REPRESENTATIVE of the propeffy ovm~ or ¢ollha~to~. <br /> <br /> Mailing Adfl~ss <br /> <br />4. FEE SCHEDULE <br /> <br /> A. VALUATION (See'"Valuation Schedule" to dat~xmine valuation based <br /> <br />on square footage of project.) <br /> <br />(1) Permlt Fve <br /> <br />(2) 5% Sta~ Surcharge (.05 x Al) <br /> <br />(3) Structural PIan Review (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan Review (.40% x Al) <br />(5) Zoning Surcherg~, if applicable (.05% x Al) <br />(6) Seismic Surcharge <br /> <br />Val~afion:$ <br /> <br />=$ <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 150 days. <br />NameofApplicant(PleasePrint~')~'r'. ~__~0/%) ~ 30U~ Phone: <br /> <br />MC 15-73 Rev 1/95 <br /> <br /> <br />