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FOR OFFIQE USE~ONLY <br />I Receiv~ By: f.,2b- ,q ~ <br />IZoning Validatio~ ~ <br />[pate: 4/121/%~r <br /> <br />MARION COUNTY BUILDJ~IG INSPECTION "MR OFFICE USE ONLY <br />Salem, OR97~ I~t ! e Rear: JO <br /> <br /> FAX 588-7948 <br />BUILDING PERMIT APPLII t Ib UNI¥ <br /> <br />COIVfPLETE ALL SECTIONS, 1 THROUGH 4 BUILDING INSPECTION <br />1, Job Description <br /> <br />RES,I~ENTIAL COMMERCIAL (>New Use of Smlcmre: <br />( ~ Addition ( ) Relocation ( ) Addition ( ) Sign g5 <br /> ( )Alteration ( )Demolition ( )Alteration ( )Demo:tim ~"~dP'~ <br /> (~ccc~aoI~ ( )Odier ( )Chang¢ofO¢¢~pancy ( )Other <br /> <br />%uss( ) orRafter( > ' [Nd'Stores / mcu~ntLo~aor~um~erofV.~3ioye~, .~?..~t~ro'gm;: <br /> <br />2. Location of Installation <br /> <br />Subdividon L~ g <br />s=,i ' ' ' .......... <br /> To~sh~p, ~ Range ~/ Zone ~ Map WaterSu~ly: <br /> "' PrivamWel[ ( ) Spring <br />LotWidlh ffff LotDepth ~ Ac~ I~eg.~t fro Comer ~O Community Wen ( ) City <br /> <br />3. Contractor Information <br /> <br /> ( ) I own, mdde in, or will ~side ~ ~e completed structure. <br /> <br /> ( ) I undemand ~at I musl ~gi~er as a eomtmeflol contractor if ~e structure is sold or offered for role before or u~n comp]edm~. <br /> <br />(V) Ifirn, registered builderOR thcauflmrized representa~eofaregistemd builder, /9~.t~£gl//~ ~)~'~ <br /> <br />^,chitect name: g]~/~ ¥ [MaiiMg ~ad=~: Il, hone: <br /> Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> <br /> to det~tmth~ valuation ba~ed on <br /> <br /> (l) Permit Fee <br /> <br /> (2) 5% Slam Slltcharge (,05 x Al) <br /> <br /> (3) Stm¢[ural Plan Review (,65% x Al) <br /> (4) Fire & Lilg Safety Plan Review (,40% x Al) <br /> ( 5 ) '~.4~-thvg'~' appUcable (.05% x A 1 ) <br /> <br />(1) Driveway w/curb@ $7,50 <br /> <br />(2) Driveway w/o curb @ $1%00 <br /> <br />(3) Sim Plan Review (ecmlmercial only) @ $79.00 <br /> <br />(4) Addlt/oaal Plan Review~ or Addcndian~ <br /> <br />(5) J~lvestigation Pee <br /> <br />(6) Rein~pectio~l Fee @ $25,00 <br /> <br />reverse side of~is t'onn, <br /> <br />MC 15-73 11/91 <br /> <br /> <br />