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FOR CITY USE ONLY <br />Received By:. <br /> <br />MAR/ON COUNTY BUILD/NG INSPECTION :' ........................................................... <br />COMMm~TY DEV~LOPME~rr cm, rrr~ i FOR CITY USE ONLY <br /> 3150 Lancaster Dr. ~ - Suite C i City Setbacks: <br /> Salem, Oregon 97305 i Front: Rear: <br /> 8:00 am - 4:30 pm i Left: Right:_ _ <br /> 24 Ia'. Inspection Line 373-4427 <br /> FAX 588-7948 i Special: <br /> <br />1. JOB DESCR]PI~ON <br />RESIDENTIAL <br /> <br /> ( ) Alm'a~on <br /> ( ) Ad6i~on <br /> <br />BUILDING PERMIT APPLICATION <br /> <br />() Aceessot~ ( ) Addeudmn <br /> <br />De~ctipl~ of Work: <br /> <br />lsi Floor. 2nd Floor: <br /> <br />COMMERCIAL <br />~ NM' ( ) Multi Family <br />( ) Alteration ( ) Addendum <br />( ) Addition ( ) Sign <br />( )Other <br /> <br />( ) Cl~mgn of Ocvupmcy or Use <br />( ) Manu faowre d Dwallin g Pank <br />'X~4 Reereatinnal Vehi*l~ <br /> <br />Use of Structure: ~; Fmergy: <br /> <br />Other: No. Stode,: [ Ung~: / tteight:~T'~).. <br /> <br />Number of Employees: Seating Capacity: Number of I~drooms: Exi~ng: Proposed: <br />2. LOCATION OF INSTALLATION <br /> <br /> · ~".~.q ~.v' /--~-. r Marlin A ~' · · ~e. <br /> <br />Sub.isis:, · ] ~t: Block <br />( ) Mob~e Home P~ ~ f~ ~S~ ~e ~: / Total g Spies: <br /> <br />~o~ ~: r~,l ~: ~ g~ ~ [ W~ supply: ~ ~ate Well ( ) ~ Well <br /> I <br /> c~ <br /> <br />3. CONTRACTOR INFORMATION -- pLEASE INDld %TEWHOISDOINGTHEWORK <br /> <br /> 0 ~anthePR~PE~T¥~NERand~wn~idein~rwill~sideinthec~mp~t~dstm~tur~andwi~bemy~wng~twra~nt~act~r~ I undid thai I must <br /> r~g~er as a col~tuction conh'a~or if Ihe s~tu~u~ ia sold or offered for sale beforo or upon completion. If I hi~ subcoma'actora, I will hi~ only subcona'ac~om <br /> registered wilh the Constriction Contractors Board. ff I change my mind and do hire a general eonlractor who is registered with the Commlotion Conlr~tors <br /> Board, I will immediately notify Mzlion County of tho namo of the contra~or. <br /> <br />() <br /> <br />() <br /> <br />Zip: <br /> <br />Mailing <br />Addre~: <br /> <br />Street City: Zip: Phone: Fax: <br /> <br />4. FEES <br /> <br /> A. VALUATION (Se~ Valuation Schedule to determine the valuation <br /> ba~ed on square footage of the project) $ <br /> <br />(1) Permit Fee <br />(2) S~ate Surcharge (5% x Al) <br />(3) Structural Plan Review (65% x A 1) <br />(4) Fire and Life Safety Plan Review (40% x Al) <br />(5) Zoning Surcharge, if applicable (6% x Al) <br />(6) Seismic Surcharge, if applicable (1% x A1 ) <br /> <br />I hex~by certify that the above information is correct. Permits are non-trans <br /> <br />B. Miseetlaneeus Fees <br /> <br /> (1) Addl Plan Review / Addendum ~ S501 hr, <br /> Minimum one-half hour $ <br /> (2) Reinspection Fee ~ $50~er inspection S <br /> (3) Invcsti4ation Fee $ . <br /> (4) Inspections outside norraa/business <br /> Hours ~ $50/hr, minimum txvo hours $ <br /> (5) Inspections for which no fee is specifically <br /> Indicated ~ $50/hr; minimtma one hour <br /> (6) Additional Sets of Plans ~ SlOper set <br /> TOTAL $ <br />axable and ext)i~ if work is not started within 180 days of issuance or if wc~ <br /> <br />suspended for 180 days. <br />Nan~e of Applicant [Please Print]: ~Y"~'~.~_~ ~0~4], / ~. ~ <br /> <br />Sig~t~ ofA~lic~t: ~ ~ Date: <br />MC 15-73 ~v 9/98 <br /> <br /> <br />