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MARION COUNTY BUILDING iNSPECTION ~ US~E ONL~Y <br /> 220 High Street NE I City Setback Req/drements; <br /> Salem, OR 9730~,~ ....... ~ /~¢" ]~: /~ / <br /> <br /> FAX 588-7948 ~ B J ~ ' <br /> BUmDING PERM APPLiC <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4. MARION ~;OLINTY <br /> <br />RESIn .ENTIAL COMMERCIAL ~ ~o~q.~,,u ........ L~s~%f sim(lure: <br />( )Addition ( )Relocaaon ( )Addjtlon ( )Sign <br />( )Dcmo~d~ ( )~mtion ( )Demobti~ <br />(~Avve~sow ( )O~er ( )O~angeofOccu~ncy ( )O~cr <br /> <br />2. Location of Installation d,~l'W//~. ¢73'2.5- <br /> <br /> ~ 'I~x Acct No <br />RthXaa~ ~ Ye~; 6~. ' ~2~g ................ C~o~,St~, <br />SubdMslon I Lot ............ Blt~k <br /> <br />~tWidth ~ LolDepth ~,S- ACm~,,, I,reg. lmt ~ Comer ~ Commun:typdVateWellwell(( )SFdng ( )/) Chy <br /> <br />3. Contractor Information <br /> <br /> ( ) l~n. resid~ ~, or w~ reside m thc completed stmctu~. <br /> <br /> ( ) ~ wffi be my own g~eml contra~or. <br /> <br />( I~a,~l a rcgistete, d build*t OR the authorized repmsea~adv¢ of a registered btdlder. ~zt.pt4.~¢l, I/~, ~r-~_ ~ 7 ~..~ ~' <br /> <br />Archilec, name: /¢Z/./V/4- ~. [ Mailthg Address: I Phone: <br />4, Fee Schedule <br /> <br />A. VALUATION (S*e "Valuation S(hethae" <br /> [o d~t~nnine valuation based on <br /> square footage.) <br /> (1) Permit Fee <br /> <br /> (2) 5% State Surchar(e (.05 x Al) <br /> <br /> (3) SImcmral i lan Review (,65% x Al) <br /> <br /> (4) Fire & l,lfe Safety I la I<¢vlew (.40 ~o x Al) <br /> (5) ~a~ge. if applicable (,05% x A I ) <br /> <br />Vateatiom $_ '~ <br /> <br /> = <br /> <br /> = <br /> <br />(1) Driveway w/a, cb Ct~ $7.50 <br /> <br />(2) Driveway w/o cud~ (¢ $17.00 <br /> <br />(3) Site Plan Review (commercial only) Ca) $79.(×1 <br /> <br />(~) Additional Plan Reviews or Addendum~ <br /> <br />(5) Investigation Fee <br /> <br />(6) Rcins~ct~on Fc¢~ $25.00 <br /> <br />(7) Othur ~cdms not ~sted above <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />