Laserfiche WebLink
COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />RESIDF/qTIAL <br />Addition ( ) Relocation <br />Alteration ( ) Other <br />Accessory <br /> <br />Deseripti0n of Work <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITy DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> <br /> 111 r I~ f1't~$8..7948 <br /> <br /> . <br /> <br /> ) Alteration ~C~'/Odl ) 'g <br /> ,ir <br /> ) Change of Occupancy ) Other <br /> <br />IMain Floor: <br /> <br />IFOR CITY USE ONLY <br /> <br />Use of S~'ucture: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />l) <br /> <br /> () <br /> <br />4. FEE SCHEDULE <br /> <br />on square footage of project.) Valuation: $ <br />(1) Permit F~ <br />(2) 5% Stat~ Surcharge (.05 x Al) <br />O) st~r~l n~. R~w (.6s% x AZ) ~'7. <br />(4) Flm & Life Safety Plan Review (.40% x Al) <br />(5) Zoning Surcharge, if applicable (.05% x Al) -~ <br />(6) Seismic Surcharge <br /> <br />I hereby certify that the above information is con'ect. <br /> <br />(2) Inveatigation Fee <br /> <br />(3) R¢inaFection Fee ~ $25.00 <br /> <br />(4) Offer Inspections not l~s~l above <br /> <br />Permits am non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 clays. <br /> <br />SignatureofApplicant: _N~~ ~,/ C~_~t~'r-~__ Date: ' <br />MC 15-73 Rev 1/95 / <br /> <br /> <br />