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IgOR CITY VALIDATION [ MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br /> <br />I ' ~, ! ~/,, ~ Salem, Oregon97301 l~ont: Reax:. ~ ~' <br />]Zoning Validation: ' ~ ~ fgaOdam..4:30pm Phone 585-5147 <br /> <br />...... - /~//,.~,~x ~.~ <br /> B~~ ~PPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 ' '~' ~ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />on square foovtge of project,) Valuaaon: $ ~--~o O <br />(1) Penr~t Fee Il. <br />(2) 5% State Surcharge (.05 x Al) = t <br />(3) Sla. uelural Plan R~view (.65% x Al) = "~ - <br />(4) Fire & Life Safely Plan Review (,40% x Al) -- <br /> <br />(6) ~eismic Surcharge = <br /> <br />TOTAL <br /> <br />=$ <br /> <br />I hereby certify that the above information is correct. <br />Permits are no~-transfertable and expire if work is not slatted within 180 days of issuance or if work is suspended for 180 days. <br /> <br /> <br />