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FOI~CITY U~L~ ( ~_~'~ COMMUNITY D~LOP~ CE~R <br /> R~ ~:~~ate: ~~n ~C~ ~. ~ - S~te C <br /> ~m.g~: ~ C,~: (~r~l :~lV~lst~ ~ on97305 <br /> <br /> , OU~ U I I~ F~588-7948 <br /> <br />t job D~sc~zo~ ~ U~~E ~ APPLICATION <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br />P, t: <br /> <br />( ) New ~ Accessory ( ) Addendum <br />( ) Alteration ( ) Relocation ( ) Other <br /> <br />Square Footage: Basement: ~ 1st Floor: ~ 2nd Floor: <br /> <br />Number of Employees: ~-~ Sealing <br /> <br />( ) New ( ) Multi Family <br />( ) Alteration ( ) Addendum <br />( ) Addition ( ) Sign <br />( ) Other <br /> <br />( ) Change of Occugnncy or Use <br />( ) Manufactured Dwelling Park <br />( ) Recreational Vehicle Park <br /> <br />Other: ~ No. Stories:-- Uni~: -- Height: <br /> <br />Number of Bedrooms: Existing: Proposed;' <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />( ) Mobile Home ~ ( ) Mobile Home Subdiv~ion Sp~e <br /> <br />CONTRACTOR INFORMATION --- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> I am the PROPERTY OWNER and own, reside in, or will r~side in the completed slt'ueture and will be my own general corr. I undoratand that I must <br /> register as a construction contractor if the stngtur~ is sold or offered for sale befor~ or upon completion. If I hire subconUaeto~, I will hire only subeontraetom <br /> registered wi~h the Construction Contractors Board. Ill change my mind and do hire a general contsaetor who is registered with the Construction ConU'aetor~ <br /> Board, I will imanediat~ly notify Marion County of the n~ of the con,actor. <br /> <br /> ( ) I am the AUTHORIZED REPRESENTATIVE of the prol~rty owner or the <br /> Business Name (please Print)_ <br /> <br />Mai~g Address: <br /> St~et City: Zip: Phone: <br /> <br />() <br /> <br />I am a CONTRACTOR r~gister~d with the Stat~ of Oregon. <br />Business Name (please print): <br /> <br />RegWa'~ion #: <br /> <br />Mailing <br />Address: <br /> <br /> Street City: Zip: Phone: Fax: <br />4. FEES <br /> <br />A. VALUATION (See Vahiation Schedule to determine the valuation <br />based on square footage of the project ) $ <br /> <br />(1) Permit Fee <br />(2) State Surcharge (5% x Al) <br />(3) Sha~ctuml Plan Review (65% x Al) 3 ~'' <br />(4) Fire and Life Safety Plan Review (40% x Al) <br />(5) Zoning Surcharge, if applicable (6% x Al) <br />(6) Seismic Surcbaxrge, if applicable (1% x Al) <br /> <br />B. Miscellaneous Fees <br /> <br />(I) Addl Plan Review / Addendum ~ $50/hr, <br /> Minimum one-half hour <br />(2) Rehispeefion Fee ~ $50/p~r inspection <br />(3) Investigation Fee <br />(4) Inspections outside normal bus'mess <br /> Hours @ $50/hr, minimum two hours <br />(5) Inspections for which no fee is specifically <br /> Indicated @ $50/hr, m'mimum one hour <br />(6) Additional Sets of Plans @ $10 per set <br /> TOTAL <br /> <br />I hereby certify that thc above information is co~t. Permits are non-transferrable and expire if work is not started within 180 days of issumme or if work <br /> <br />SignatureofApplicam: (.q~,~.~_ ~.~.~ - - ' DaW: ~- ~-~ <br />MC 15~73 Rev 9/98 <br /> <br /> <br />