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~O.R.,~!~Y VALIDATIO ,N [ <br />Zoning Validation: _ .~"_ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CEi'~I'ER <br /> 285 Chmh St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:3Opm Phone 588-S147 <br /> 24 hr. Inspection Line 588-7904 <br /> FAX 5~8-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br /> FOR CITY USE ONLY <br /> <br />~RS~: (~ ~i~,si~,: .~ <br /> <br />~ COIVIML~'RCIAL Use of SUucture: <br />( )Addition ( )Relocalion '(.~).~[diti°n ()New <br /> ( ) Alteration ( ) Other teration ( ) Sign <br /> <br /> ( )Accessory ( )ChangeofOccupan?~ .... (.)Other <br /> <br />LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> I am the PROPRRTY OWNER and own, reside in. or will rcalde in the completed stracture and will be my own general contractor. I undersm~d that I must register as a ¢onstcuciloa <br /> conlractor if the structure ia sold or offered for sate befo~ or upon compl~tlon. If I hire subcontractors, I will hire only subcontractors registered with thc Constmcilon Conh'actors B~ni, <br /> If I change my mind and do hire a g~nexal contractor who is registered with the Construcilo~ Contractor~ Board, I will imme~ia~ly notify Marion County of Cae name of g~ imm.actor, <br /> ( ) I am a CONTRACTOR registerexi with thc S~a~ of Oregon. <br /> <br />Business Name <br /> <br />Matilng Address <br /> <br />( ) I am an AUTHORIZED RRPRF~RNTATIVE of the propony owner or contractor. <br /> <br />4. FEE SCHEDULE <br /> <br /> ~-o <br />on squar~ footage orproject.) Vatuailon: $ ~. ~ <br /> <br />(1) Petit Fee <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />O) StmCmrat Plan Review (.65% x Al) <br /> <br />(4) Fire & Life Safe~y Plan Rcvinw (.40% x Al) <br />(.%~"~.~uu r char g e, if applicable (.O5~x~At) <br />(6) Seismic Surcharg~ <br /> <br />B. Miscellaneous Fees <br /> (1) Additional Plan R~views or Addendums <br /> (2) Inve~ilgation Fee <br /> (3) Reinspecilon Fee ~ $25,00 <br /> <br />I hereby certify that the above information is correct. <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 Applicant (Please Print): Phone: <br />Signature of Applicant: ~ Date: <br />MC 15-73 Rev 1/95 <br /> <br /> <br />