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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> $:00am - 4:30~m Phone 588.5147 <br /> Code-A-l:'hon¢ 588-7904 <br /> PAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALI,, SECTIONS, 1 THROUGH 4 <br /> <br />1. ,lob Description <br /> <br />[FOR OFFICE USE ONLY <br /> <br />RESI'D EN'I'IAL <br /> <br /> ( ) Addition ( )Relocation <br /> ( ) Allemtion ( )Demolifie~ <br /> ( ) AeeessoW ( )Other <br /> <br />COMMERCIAL (~) New <br />( )Addition ( )Sign <br />( ) Altcra~on ( ) Demolition <br />( ) Change of Occupancy ( ) Other <br /> <br />Tmon( ) or Rafter(~ [ No, S~o~[e~ i OeeupantLoadorNum~r~mployees ~n~ ..... No. Bedrvom*: <br />2. LocatiOn oflnstallafion g O, ~ ~.~ <br /> <br /> ~ ~ Site No. ,,, <br /> <br />Mobile bIome Pa~ c <br /> ,, <br /> <br />3. Contractor Information <br /> <br />Prol~rty Owner I MatlZng Addreg~ I Phon~J NO: <br /> <br />) I own, mskl¢ itl, or will reside in the completed stracture. <br /> <br />) I understand that i lllllSt register as a constnlctioo eommctor if the $1Bl~ufe J.s sold or offered roi' $&le before Or u~on eomplelion, <br /> <br />) I wi//be my own gcmcral contractor. <br /> <br />A. VALUZLi'ION (Sca "Valuation Schedule'* <br /> <br /> (1) permit gee <br /> <br /> (2) 5% State Surcharge 605 x Al) <br /> <br /> (3) Structural Plan Review (.6.5% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (.40% x Al) <br /> (5) Z, oning Sumharge, ir applicable (,05% x A 1 ) <br /> <br /> (1) Driveway w/curb@ $7.50 = . ........ <br /> (2) Driveway w/o curb @ $17,00 <br /> (~) Site Plan Review (cOirunerciai only) @ $79.00 ~ __ ..... <br /> (4) Additional Plan F. evicws or Afldendums * <br /> (5) Investigation Fee = __ <br /> (6) Rehspcctlon Fee@ $25,00 <br /> <br />RECEIPT: <br /> <br />MC 15-7~ Rcv, 11/91 <br /> <br /> <br />