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FOR CITY VALIDATION / MARION COUNTY BUILDING INSPECTION ]' FOR CITY USE ONLY <br /> · /'/'~ /q L COMMUNITY DEVELOPMENT CEN'rER r <br /> Received By' Loz4' ~ / f'W/jq/~Tf~.-~ 285 Church St. NE - Room 132 ]City Se~ek <br /> ~ -' / O'~,~ O. [ Salem, Oregon97301 <br /> I- <br /> Zoning <br /> Yalidation: ' "/O%oee-<~r'~[ 8:00am-4:30pm Phone 588-$147 Iv~t: <br />!lm'~' ..... .9-/(-/- ~')F_ -- -- ~, ~1 24 hr. InSl~tion Line 588.7904FAX 588-7948 JL~ Si~: <br /> BUILDING PERM~'TION <br />COM 'L TE ^LC SECnONS, I Tm oua. 4 <br />l. jOaDESCmrnON I a t99 <br /> <br /> RESIDENTIAL COMMERCIAL Use of Structure: <br /> ( ) Addition ( ) Relocation ( ) Addition MARION O. OU} ?¥ <br /> gn <br /> <br /> ( ) AccesSO~ ( ) Ch~ge of ~cupancy ( ) Other <br /> <br />~,rgy Pa~: i No. Stode, / I No. of Employees: ~ishng - ~ New- <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Range ~ ~ne ~f Map Wa~r Supply: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> NarRc <br /> Malllng Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br /> A. VALUATION (See "Valuation Schedule" to determine valuation based <br /> <br /> ~-t9 oo <br />on square footage of project,) Valuation: $ <br /> <br />(]) Perndt Fee _.4"'g · <br /> <br />(3) Structural Plan Review (.65% x All <br /> O <br /> <br />B. Miscellaneous Fees <br /> (l) Additional Plan Reviews or Addendums <br /> (2) Investigation Fr~ <br /> (3) Reinspection Fee @ $25.00 <br /> (4) Other Inspections not listed above <br /> <br />I hereby cerlify that the above information is correct. <br />permits are non4ransferrable and expire if work is not started within 180 days of issuance or if work is suspended ['or 180 days. <br /> <br />Name of Applicant (Please print): _~J'~'~I~ ~/~f'~ ~ .Phone: <br /> <br /> <br />