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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVE~O~ CENTER <br /> 285 Church St. ND. - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am*4:30pm Phone S88-514~ <br /> 24 hr. lmpeeQon Line $88-7~04 <br /> FAX ~8-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />FOR CITY USE ONLY <br /> <br />1. job DESCPaPTXON D~E]T~E~ <br /> CO~! il L~.~ <br /> <br />RESIDENTIAL CO~! ]{ '-~{ U~e of Stmcm~: <br />(~'~ddition ( )Re!ocntion ( )AddiSon ( )New <br />()Alteration ()Other <br />( ) Accessot-./ (~,~ ~C~ ~ ( )Other <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION m PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am the P.R. OPERTY O.WN~.. nnd own, mzlde in, ~ will reskle in the con~ sm~,ture ~d will ~ my ~n ~ ~. i u~ ~ i m~ ~ u a ~ <br /> contrnc~or ff ~ si~uctu~ ~s .~. Id o~ off, red fo~ ~nle bef~ o~ upon ~on~Reti~ ff I hlre subconuacto~, I v~ill hi~ only ~ ~ ~ ~ ~ ~ ~. <br /> <br />4. FEE SCHEDULE <br /> <br />(1) Penuit Fee <br />(3) Smsctural Plan Review (.6~ x Al) 2~',S"~, ~.~ <br /> <br />(6)SeismicSurchatge = 7 / ~ L ~ <br /> <br />I hereby ceflify that the above information is correct. <br />Permits ~e non-iransferrable and expire if work isnot star~l wilhin 180 days of isauaoce or if work is suspended for 180 days. <br /> <br />SignaturuofApplicant: ~ ])ate: ~ <br />MC 15-73 Rev 1/95 <br /> <br /> <br />