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FOR CITY USE ONLY <br />Received By: Date: <br />zoning By: _City: <br /> <br /> MARION COLrNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. HE - Suite C <br /> Salent, Oregon 97305 <br /> 8:00 am - 4:30 pm <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />BUILDING PERMIT APPLICATION <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br /> <br /> I 1 199 <br /> <br />1. JOB DESCRIPTION <br /> <br />RESIDENTIAL ) New <br /> ) Alteration <br /> ) Addition <br /> <br />() Accessory ( ) Addendum <br /> <br />( ) Relocation ( ) Other <br /> <br />Square Footage: Basement: 1st Floor: 2nd Floor: <br /> <br />) Alteration . ( ) Addendum <br />) Additio~ ( ) sign <br /> <br /> Mamfl# ~DUNTY <br />commeRCIAL ..... BUILOING Ilffho gl'ION <br /> ) New ( ~ ~in r~i~y ( ) Ch~ge of ~cup~cy or Use <br /> ( ) M~ufaq~d ~ell~g P~ <br /> ( ) Re~ation~ Vehicle P~ <br /> <br />~)~ Other ~ <br /> <br />Use of Structure: Occupancy: Energy: <br /> <br />Other: No. Stories: Unikq: Height: <br /> <br />Number of Emp!oyees: S~g Capacity: <br /> <br />Number ~f Bedrooms: Existing: Proposed: <br /> <br />P~celO,vner: ~~S~ II&MMling,Ad&ess: ~0' ~ Ilo CiW:~}~ ~l ~one: <br /> <br />( ) Mobile Home P~ ( ) Mobile H~e Subdivision Space fi: : To~l ~ Spaces: <br />Map: ~ne: P~elS~e: ~ () SF ~C UGB: ()Y <br /> <br />~o~ ~cator: P~cel g: water Supply: 'va~ Well ( ) C0mmun~ Well <br /> CiW <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />I am the PROPERTY OWNER and own, reside in, or vdll resMe in the completed structure and will be my own general contractor. I understand ~hat I must <br />register as a construction contractor if the structure is sold or offel~d for sale before or upon completion. If I hire subcontractors, I will hire only subcontractors <br />r~giatered with the Construction Contractom Bo&rd. ff I change my mind and do hire a general contractor who is registered with the Construction Contra~tom <br />Board, I will immediately notify Marion County of the name of the contractor. <br /> <br />() <br /> <br />Business Name (please print)__ <br /> <br />Mailing Address: <br /> Street City: Zip: Phone: <br /> <br />4. FEES <br /> <br />A. VALUATION (See Valuation Schedule to determiua the valuation <br />based on square footage of the project) $ <br /> <br />(1) Permit Fee <br />(2) State Surcharge (5% x Al) <br />(3) Structural Plan Review (65% x Al) <br />(4) Fire and Life Safety Plan Review (40% x Al) <br />(5) Zoning Surcharge, it' applicable (6% x A] ) <br />(6) Seismic Surcharge, if applicable ( 1% x A1 ) <br /> <br />B. Miscellaneous Fees <br /> <br />(l) Addl Plan Review / Addendum @ $50/hr, <br /> Minimum one-half hour <br />(2) ReJnspection Fee ~ $50/per inspection <br />(3) InvesXigation Fee <br />(4) htspectioua outside normal business <br /> Hours ~ $50/hr, minimum two hours <br />(5) Inspections for which no fee is specifically <br /> Indicated @ $50/hr, minimum one hour <br />(6) Additional Sets of Plans ~ $10 per set <br /> TOTAL <br /> <br />I hereby certify tlmt the above information is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work <br />suspended for 180 days .... <br /> <br /> Mailing Address: ~'O,~O)q~[[~ ~h.l~-.91L[~ ?DI~ ~7~ <br /> erode: 3 q-qq 4q <br /> / I <br />SignamreofApplicant: ~,...~g~A ..... ~ Date: II]~;t'r~ <br />MC 15-73 Rev 9/98 ~"" ~- ' ' <br /> <br /> <br />