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rod <br /> Received By: ~ / 1¢\/-~¢ <br />[ Zoning Vali~tion~~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE ~: ~ /F;~ ~ ~ <br /> Salem, OR 97301 ]~ ~ (U~ t~- <br /> 8:00~ - 4:~m P~ne 588-~ 1~ ~ <br /> F~ 588-7948 ,- <br /> <br />FOR OFFiCE,USE ONLY <br /> <br />BUILDING PERMIT APPLICATI~i0N <br /> <br />COMPLETE ALL SECTIONS. 1 THROUGH <br /> <br />1. Job Deserlption <br /> <br />RBSIDFRqTIAL CO~IMERCIAL ( ) New U~e of Slmcl,ure; <br />() Addition ( )Relocation ( )Addition ( )Sign <br />( )Alteration (L~-ex~olition ( )Alteration ~Demolifion <br />( )Acce~mry ( )Other ( )ChangeofOccupancy ( )Other <br /> <br />2. Lo~ationofInstaIlation ~,~ ~ c~ <br /> <br />Mo~e llome Park S~ce g <br /> , PdvamWell ( ) Spring <br /> <br />3. Contractor Information ~ ¢.-.-.-.-.-.-.-.-.-~B ~ <br /> <br /> ( ) I own. reside b. ~ wi~ reside ~ the completed stature. <br /> <br /> ( ) I undemand ~at [ must register as a constmcfi~ contractor ff ~e s[mcmre is sold or offered for sale before or uvm c(~pletion. <br /> ~1 will be my own gmemI c~tracton <br /> <br />Comraetor Business name & #: I Mailhtg Address: I Phone: <br /> ( ) I am a registered builder OR [lie authorized mpresemal/ve of a regismred boHder <br /> <br />Archi~ecl name: I MaJling Address: I Phone: <br />4. Fee Schedule <br /> <br />A, VAt.UAT~ON (8¢¢ "Valuation Schedule" <br /> <br /> square footage,) Valualion: <br /> (1) I'~nnil F¢¢ <br /> (2) 5% State Surcharge (.05 x Al) = <br /> (3) Smlcmrat lz'lilxt Review 065% x Al) = __ <br /> <br />(1) Driveway w/curb (¢_ $7.50 <br /> <br />(2) Driveway w/o curb (a~ <br /> <br />(3) Site Plan Review (commercial ~mly) (¢ $79,(h9 <br /> <br />(4) Additional Plan Reviews or Addendums <br /> <br />(5) ~vcstigatJon Fcc <br /> <br />(6) Reia~cfiou lrce (q3 $25.00 <br /> <br /> <br />