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/FOI~ CITY; VALIDATION <br />Rec~b/ed By: __ <br />Zoning Validation: <br /> <br />IDate: <br /> <br />COMPLETE ALL SECTIONS 1 THROUGH 4 <br />1. JOB DESCRIFI'ION <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 />FOR CITY USE ONLY <br /> <br /> RESIDENTIAL ' COMMERCIAL Use of Structure: <br /> ( )Addition ( )Relocation C )Addition ( )New <br /> ( . )~.t~mtion ( ) Other ( ) Alteration ( ) Sign <br /> (/~ Accessory ( ) Change of Occupancy ( ) Other <br />DraeriptionofWork /t~t' ~.~ //3<1./_~. lathlsahistodcalbuilding? Yes <br />[ I No. Bexh~oms: <br />Square Foulag* -B asemeat: ] Main Floot:~ ¢~$econd ,loot: [Garage: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> I am One PROPERTY OWNER and own, reside in, or will residd in the ~ompleted structure and will be my own general contractor. 1 under~tand that I must registar as a construction <br /> /' <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />VALUATION (See "Valuation Schedule" to determine valuation based <br /> <br />on square footage of project.) Valuation: $ <br />(1) Pelmit <br />(2) 5% Stale Surcharge (.05 x Al) <br />(3) Strilctural Plan Review (,65% x Al) <br />(4) Fh~ & Life Safety Plan Review (.40% x Al) <br /> <br />(1) Additional Pt~n Reviews or Addendums <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Penalts are non-transferrable and expire if work is not started wi~ days of issuance or Jf work is suspended for 180 days. <br />Name o f Applicant (Please Pdnt): ~'~~ //~'~/f ~ t~ _/~'~ Phone: <br /> <br /> <br />