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C TY Wt,m T O [ <br />Received By: __ [ <br />Zoning Validation: I <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 $88-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />L JOB DESCRIPTION <br /> <br />FOR CITY USE ~ <br /> <br />RESIDENTIAL ' COMMERCIAL Use of Stxucture: <br />( )Alteration ( )Other ( )Alteration ( )Sign <br />( )Accessory ( )ChangeofOccupancy ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WI-lO I$ DOING THE WORK <br /> <br /> I <br /> am the PROPERTY OWNER ~nd own, reside in, or will reside in me completed slructure and will be my own g~nemi con,factor. I understand that I must mgisa:r as a construction <br /> <br />( ) I am an AUTHORIZED REPRESENTATIVE of tl~ property owner or cony:actor. <br /> <br />Mailkng Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION (Se~ "Valuation Schedule" to detcrmi.e valuation bas~l <br /> <br />on square footage of project.) Valuation: $ <br />(1) t'~nnit l%e <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 A 1) <br />(6) Seismic Surcharge <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and elpire ~is not started within 180 days of issuance or if work is suspended for 180 days. <br /> 7- o - <br /> <br />MC 15-73 R~v 1~95 ~ <br /> <br /> <br />