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FQR CZ~Y VALIDATION <br /> <br />Zoning Validation: ~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRWTION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOP~ ~ 285 Church St. NE - R~'i~ <br /> S,,em, O gon <br /> <br /> ~ ~r. ~m~lo,, Lr,,~ff~-7~4 '"' iff/ /.~ <br /> FAX 888-7948"~ . - <br /> BUILDING PERMIT APPI~[/~i~I'I~ ~,.,0~ <br /> ~UILOiNT'~. C ]UIVTv <br /> <br />RESIDENTIAL <br /> <br /> ( ) Addition ( ) Relocation <br /> ( ) Alteration ('~ Other <br /> ( )Accessory At~'~ ~ ~161 <br /> <br />Path: J No. Stodes <br /> <br />COMMERCIAL <br />( ) Addition ( vS~ew <br />( ffAlt~o, ( <br />( ) C'ha~e of Occupancy ( ) Other <br /> <br />JNo. of F_.mploycca: Existing - New - <br /> <br />JSecoM Flooc. J Garage: <br /> <br />FOR CITY USE ONLY <br /> <br />Is this a historical building? Yes - (~ <br /> J <br /> No. Bedrooms: <br /> I Oth~. I mi~t: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Home Park <br /> <br /> · I <br />L~W~h .fro ~ / Lotted, th /00 f <br /> <br />mo= No. 502 .~qq - ~zo~ t. <br /> <br />Block <br /> <br />Water Supply: <br />Private Wel~ ( ) Spring <br />Commu~yWell ( ) ~ty <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand ~hat I must register as a consm~ction <br />c. ontmc~ if the sm~m~ is ~old or offered for sale before or upon completion. If I hire subcontractors, I will hire only subcontractors registemi wi~h ~e ConsUuction Contractors Board. <br />If I change my mind and do ~ a general conWactor who is registered with the Construction Conlractors Board, I will immediately notify Marion County of the name of the conlractor. <br />I am a CONTRACTOR registered with the State of Oregen. <br />Business Name gegistmion No. <br />am ~n A~HIORIZF_~ R~RI~.NT~TI~ of ll~ proporty owner or ¢omraetor. ~ <br /> <br />4. FEE SCHEDULE <br /> <br />A. VALUATION (See "Valuation Schedule" to determine valuation based <br /> <br /> on square footage of project) Valuation: $ 5600. O0 <br /> (1) Permit Fee 56.50 <br /> (2) 5% sine Suteh~,~ (.05 x A~) = 2.83 <br /> (3)St~t,~dP~,4~,,(.~5%xA~) = 36.73 <br /> (4)~t~ Ett~iit--ety"l'~ ~,,e~-~ 0tl~ ~ ~ ~ C i t y Fee= 8.68 <br /> (5) Zoning Surelmrge. if ~oplieable (.05% x Al) = <br /> (6) Seismic Surcim'ge = <br /> <br />B. MiscoHaneous Fees (1) Additional Plan Reviews or Addondums <br /> <br /> (2) Investigation Fee <br /> <br /> (3) Reinspecfion Fee O $25.00 <br /> <br /> (4) Other Inspections not listed above <br /> <br />=$ <br /> <br />104.54 <br /> <br />I hereby ce~dfy that thc above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please PrinO: .[J ~r~_.~ p~ O...]'~'l~ l~.~.t~- Phone: <br /> <br /> <br />