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MARION COUNTY BUILDING INSPECTION <br /> SenatOr Bldg. NO, 225 <br /> 220 High Street NE <br /> <br /> ~ ' i hone 588-5147 <br /> C0~e~A-Phone 4:30 P,M,, · 8::00 AM, <br /> <br /> P,L, MB NG PERMIT APPLICATION <br /> <br />Nome Builder~ Registration NO <br /> <br />~" ~ New:: '~"'----' <br />Commercia ;; [] Alteration:; [] <br /> <br />Phone;: <br /> <br />Site Ne,, <br /> <br />Phone <br /> <br />Mailing Address' <br /> <br />Cross Street, <br /> <br />Add"ess ' <br /> <br />Addition:; [] Occupancy U~e of Building ' <br /> <br /> NO FEE AMOUNT <br /> Base Price $20 O0 <br /> Residential <br /> New construction,!~achflxture) $ 9 00 <br /> Alterations (each fixture) ........ 900 <br /> Re-located Residence (~,,,a,c.,h fixture) ....... 4.,~? ........ <br /> New Construction (each fixture) 9 00 <br /> Alterations (each fixture) ..................... 9,00 <br /> Water Lines <br /> For the first 100 feet or fra~!,o.?,!,~lereof I 20,,00__ <br /> For additiona] 100 feet 16,00 <br /> Sewer Service Lines <br /> First 100 f?!,or fraction thereof ~ 3000 <br /> Additional 100 feet 15 0g <br /> Mobile Home sewer/water connection <br /> (maximum 5 feet length) 2~00 <br /> Other (as per Q,~,psc and Building Official) ..... <br /> On-Site Technical Review (apply at Marion County ~nly) ....... ' ......... <br /> Re-ln,._spection Fee ......... 25,,00 <br /> FEE $ ~']?,.,~ ~ <br /> STATE SURCHARGE .~ .,..5-¢ <br /> PLAN REVIEW FEE $ <br /> INVESTIGATION FEE $ <br />Please return COMPLETE APPLICATION FLEETSURCHARGE $ ~ ~'~ .... <br />with the indicated fee,, CITY FEE $ <br />TOTAL $ <br /> <br />i ~¢''I am a registered builder OR ( t the authorized representative of SIGNATURE OF APPLICANT <br /> a registered buildo~ <br />( ) The work will be performed by a registered builde[, <br />( ) Other_ <br />I, ~ agree to install according to the submitted plans ~nd specifications= the laws of the state of Oregon and the ordinances of Marion County <br /> <br />MO 15-45 <br />Rev 12/87 <br /> <br /> <br />