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FOR OFFICE ~S~E ONEYI <br /> <br />MARION COUNTY BUILDING INSPECTION ]FOR OFFICE USE ONLy,, <br /> 220 High Street NE [ City Setback Reqt.;mmenta: <br /> Salem. OR 97301 , <br /> <br /> BUll,DING PERMIT APPLIC,~OI~I 0 1992 <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Deseriptlon MARI0rq COUNTY <br /> <br />RESIDENTIAL coMMERCiAL ~ut~$Jvu H'~OrCid I~ofStructum: <br />Altcra%n ( )Demo~t~on ( )Ah~mtion ( )Dcmol/tion <br />( )Aceesao~ ( )Other ( )ChangvofO?upancy (~)Othcr <br /> <br />Truss( ) or R alU:r( ) }No.S*~rie~ ']O¢cupamLoadorNumberofEmplo¥cc~ No. Bedromna <br />gquar~ Pe~t: Basemelat: Floor: <br /> <br />2. Location of Installation <br /> <br />MoNI, Hom~ Park ~, t' S~ce ~ ~ ~ <br /> ........ PfivatcWcl{ ( ) Spring <br />LotWjdth ~$/ LotDe~h ~O Y A~r~a Ig*g.~t ~O Comer ~O Conmu~vWeU( ) City <br /> <br />3. Contractor Information <br /> <br /> ~I own. mslde in. ~ ~ ~side ~ ~e ~omple~d atmau~. <br /> <br />[ Mailing <br /> <br />~i Phone No: ~7~q -~ ?~/~ <br /> <br /> ~I am a rcgist~d bu]dcr O~ $~ a~od~ ~p~scn~aw of a ~g{seed b~d~, ' <br />A~hi~ct n~ e ........... <br /> <br /> ' <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (,See "Valuation Schedule" <br /> <br /> ~quare footage.) <br /> <br /> (1) Permit Fee <br /> (2) $% S~!e Surehalge (.0~ x Al) <br /> <br /> (4) Fire & Lira Sa~ktF Pla~l Review (,d0% x Al) <br /> <br />Vale.on: <br /> <br />B. Miscellaneous Fees <br /> <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb@ S17,00 <br /> <br /> ('3) Site Plan Review (¢omner¢ial only) @ $79.00 <br /> (4) Additional Plan Reviews or Addendums <br /> (5) investiga~on Fee <br /> <br /> (6) Reimpection Fcc @ $25.00 <br /> <br />i hcrchy certify that the above {nfomlatlola is oal'~.¢[ and that I havercad and understand the lnfonnation Notice to pr(~erly Owners abo~t C~g m¢ion {es msb cg n he <br /> <br />Site evaluations. ~eptic. electrleal, lng and mechanical wo~ require se~mt¢ pe~its. Check wi~ Marion County guildhlg inspection ~t~ro m~itting this application, <br />MC 15-73 Rev. I1/91 <br /> <br /> <br />