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qOR CITY VALIDATION] <br /> <br />Zoning Validation: Ag~ .0~ [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> g:00am-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line g$8-790a <br /> FAX 585-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />L JOB DESCRIPTION <br /> <br /> FOR CITY USE ONLY <br /> <br />Front: /t~ ' Rear: /~ g <br /> <br />RF~SiDi~NTiAL ...... ~OMMERCiAL Use of Structure: <br />( ) Addition ( ) Relocation ( ) Addition ~) New <br />( )Alteratioi~ ( )Other ( )Alte~tion ()Sign <br />(~) ~.~.~?ou (....? Ch~ge of Occupancy <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> I~,a~ts~3,1,,; C',g.. a~g.~S. . .......... <br />Subdivision Lot Block <br />Mobile Home Park ~[I ~'~ ~ ~ . Spaces ~ <br />Section ~ Township ~ R~ ~ ~ ,,,,,,,~" Map Wa~egupply; <br /> ~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> () <br /> <br /> ['"~,;,~.gA~, [ 5.%,[ea,~-Oa/l~ 14,,.~..,~1~.~./)~, ~°"~ 3qq -0,127 <br /> <br />4. FEE SCHEDULE <br /> <br />A. <br /> <br />on ~uar~ footage o£ project,) Va~uaaon: $ .a~ ~, ~ <br /> <br />(I) P~rmit Fee <br /> <br />(2) 5% State Surehm'ge (,05 x Al) <br /> <br />(3) Smctural Plan R,v~w (.65% ~ ~1) ~:.. <br />,.,- -~ ~1) = <br /> <br />(5) Zoning Su~hatge, if applicable (.05% x A l ) <br /> <br />(6) Seismic <br /> <br />(2) Investigatbn Fee <br /> <br />(3) Reimpeetion Fe~ @ $25,00 <br /> <br />=$ <br /> <br />TOTAL ,,$ ~, ~' <br /> <br />Signature of Applicant: ~ _Date: <br /> <br />3--zo --qg, <br /> <br /> <br />