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FOR~CITY V~ALIDA~T.IgN <br /> <br />Zoning Validation: ~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESC~ON <br /> <br />285 Church St. NE <br />Salem. <br /> <br /> FAX 588-794 <br /> <br />BUILDING <br /> <br />FOR CITY USE ONLY <br /> <br /> RESIDENTIAL COMMERCIAL 0/~1 se of Structure: <br /> ( ) Addition ( ) Relocation ( ) Addition ( ) New <br /> ( ) Alteration ( ) Other ( ) Alteration ( ) Sign <br /> Oi~Accessory ( )ChangeofO¢cupancy ( )Other ~T~)~ (y~ / ~--~ <br /> <br />gqu~ F~mge -B~e~nt: IM~n~: I q~3 ] S~ond ~,: [ Gam~: 10~: I HeiSt: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> contractor if the stmctur~ is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire oaly subcontractors registered with the Construction Contractors Board. <br /> If I change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will hnmediately notify Marion County of the name of th~ contractor. <br /> <br /> ( ) I am a CONTRACTOR reglstered with the State of Oregon. <br /> <br /> Business Name Registration No. <br /> <br /> Marling Address Phone <br /> ( ) I am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br /> <br /> Malting Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br /> A. VALUATION (Se~ "Valuation Schedule" to deten~ne valuation based <br /> <br />on square footage of proj~t.) <br /> <br />(1) 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 Review (.40% x Al) <br />(5) Zoning Surcharge, if applicable (.05% x Al) <br />(6) Seismic Surcharge <br /> <br />B. Miscellaneous Fees <br /> <br /> (1) Additional Plan Reviews or Addendums <br /> (2) Investigation F~ <br /> (3) Relnspoetion Fee @ $25.00 <br /> (4) Other Inspections not tistdd abow <br /> <br />RECEIPT: <br /> <br />=$ <br /> <br />I hereby certify that the above information is com~ct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicimt (Please Print>: <br /> <br />Signatu~ of Applicant: <br /> <br />MC 15-73 Rev 1195 <br /> <br /> ho.e: 7%% - 5ooo <br />Date: <br /> <br /> <br />