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0~/22/99 'rue 16:04 FA~ ! 50~ 58~ 7~45 <br /> <br />~AIxAiON BL,1)G INS? <br /> <br />002 <br /> <br /> : FOR CITY USE ONLY <br /> { City Selbacks: <br /> <br /> : Left: RiF, I~ ......... <br /> ; Special; <br />M~RION COtJL!~__ , ;AX ~ss-79~8 , ; ............................................... ~::...~C... <br /> <br />( ) Addendum <br /> <br />( )New ( <br />( ) Add/tko{ ( ) Sign <br /> <br />NO. Stories: <br /> <br />Nttmber of Bedrooms: I~.~stln~ <br /> <br />Proposed:* <br /> <br />,El 3. CONTRACTOR INPORMATION -- PLEASE INDICATE WIIO IS .]~..?ICT~O~_ <br /> i am d~ PROPERI~/OWNER an~' °wa' resid~ !n' °r will s~side in ~hc c°mPlcl~d sir°~ wd will ~ my °wn 8eu~ ~n~r' i"un~e-m~nd thal.l h~..'.' <br /> ~is2r as · consmmliofl oon~actor if Ihe sinscmrc 'lc sold or offered far amc before or ~pon completion. I1' I hi~ ~ubGbflh"a~rs, I will him only subi~onb~tor~ <br /> <br /> ~..1 wdl ~cd~ly n~ Mmon ~u~ ~ n~C of ~o co~; or, , <br /> <br />() <br /> <br />I sm a CONTRACFOR t~gis~red with ~he St~ of Or~gOu. <br />l~sb~s Nm,ne (pIcasc pga0: __ <br /> <br />Mailin8 <br /> <br />City: Zip: · Phon~_: ,, <br /> <br />A. VALUATION (S~e Vahat/on Schedule to d~a~ine thc vahmtlou <br />ba~ed 9n ~luare footaZe ofit~e pr. ojcc0 $ <br /> <br />(l) permit Fcc <br />II!) State Surcharge (~%'xAl) · <br />(3).Stn3ctnral Plan R. eview (65% k Al) <br />(4) [~Fe a~d. Llfe S~=ty PI~ ~i~ (40% x Al ) <br /> <br />(6) Se~c S~ i f ~Plicablc ( 1% x A 1 ) <br /> <br /> (1) Minimum one, half hour '$ .... ' <br /> (2) P. ein~e~tiou Fee @ $50~er i~p~ction <br /> (3) Investigation Fee · S .... <br /> (4) l~ctio~s outstdc normai.busmes~ <br /> <br /> (5) I~.~fioas f~ w~ch ~ f~ is ~lly <br /> <br /> (6) ~diaon~ S~q of~ ~ Sl0 <br /> <br />Table:~d ~ if work is not ~ <br /> <br /> <br />