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*2'OR CITY VALIr~ATION MARION COUNTY BUILDING INSPECTION <br /> ~ ! ~'~. · ~z COMMUNITY DEVELOPMENT <br /> <br /> -" ~ .... Salem, Oregon 97301/~ <br />Zo n in g V alidafi on ,.' ~']~/1~;:~ 8,00am.4.30pm Phone ~.d.~ (~/~ [plvnt: <br /> <br /> ~ ~/ , <br /> BUILDING PE~IT <br /> <br />1. JOB DESC~PTION <br /> <br />( ) Addklon ( ) Relocation ( ) Addltion ( ) New <br />( ) Alteration ( ) Other ( ) Alteration ( )Sign <br />(~eces~o~ , ( ) Change of Occupancy ( ) Other <br /> <br />LOCATION OF INSTALLATION e:~/-~,,.~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING TIlE WORK <br /> <br />4. FEE SCHEDULE <br />A. <br /> <br />(1) Permit Fee <br /> <br />(3) Structural Plan Rovlow (,6~% x Al) <br /> <br /> O <br /> <br />VALUATION ($¢* "Valuation Schedule" to ~rmln~ valuation based <br /> <br />hereby certify that the above information is correct. <br /> <br />= J <br /> <br />Misgcdlan¢~us Fees <br /> (1) Additional Plan Reviews or Adde~dum$ <br /> <br /> (2) Investigation F~ <br /> <br /> (3) RelaSp~O~ F~ ~ $25,~ <br /> <br /> (4) O~r in~pgfiona ~t Ii,md a~ve <br /> <br />=$ __ <br /> <br />TOTAL =$ '~' ~'~_ <br /> <br />15-73 Rev 1/95 <br /> <br /> <br />