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/ FOR CITY USE ONLY I <br />]Received By: ~r... I <br />Izoning Validation: {~ I <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL (~ OR COMMERCIAL ( ) <br /> <br />SQUAREFEL~/~ Bas~ment: ~O IM~n~: ~ ISec°nd~°°~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-514ff'2~ <br /> co~n.~ho..Sss.~ ~91/~ <br /> FAX 588-7948 <br /> <br /> DEMOLITION PERMIT APPLICATION <br /> <br /> crt. ¢ coan, <br /> ~llll nrA,^ .. <br /> <br /> FOR CITY USE ONLY <br /> <br />City S~tback Requirements: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> I <br />Subdivision Lot ~ Block <br />Section Township Range Zone Map Water Supply: <br /> Prlva~Well ( ) Spring ( )~ <br />LotWidth LotDepth Acws lrreg, Lot Comer CoramunityWell ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am the PROPERTY OWNER and own, r~ide ia, or will reside in the completed structure and will be my own general contractor. I understand that I must register as a construction <br /> <br />FEE SCHEDULE <br /> <br />VALUATION: <br /> <br /> (minimum $2,000) <br /> <br />(See Table No. 3-A) <br /> <br />B. PERMIT FEES <br />l. Demolition <br />2. State S~charga (5% x B-l) <br />3. Zoning Surcharge ($20.00 if applicable) = $ <br />4. PlanReview Fee(65% x B-l) =$ <br />5. Investigation Fee -- $ <br />6. Reiaspection Fee $25.00 = $ <br /> 7.TOTAL O~her iaspecti°ns ($40'00/1~r hr' minimum 1 h°ur) <br /> 8. Overtime inspections ($40D01pe~x, minimum 2 hours) <br /> <br />I hereby certif3, that the above inf/o,janation is correct. <br />Permits arc--work is not started within 180 days of issuance or if work is <br /> <br />MC 15-04 Rev 3t95 ~ <br /> <br />suspended for 180 days. <br /> <br /> <br />