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FOR O~FICE USE ONLY <br /> <br />I Zoning Val/d~tion: r'~ ' <br /> ,I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High S~eet NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:30pm Phone 5g11-5147 <br /> Cofl~-A-Phon~ <br /> IAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />1. Job Description <br /> <br />FOR OFFICE USE ONLY <br /> <br />REglDENTIAL <br />Addition ( )Relocation <br />Alteration ( )Demolition <br />Accessory ( )Other <br /> <br />COMMERCIAL ( ) New <br />( ) Addition ( ) Sign <br />( i2f~Iteration ( ) Demol/tion <br />( )C'hangeofOcoupancy ( )Other <br /> <br /> No, <br /> <br />Sqllai~ Fe~t: <br /> <br />2. Location of~ <br /> <br />Mobile Ilome Park Space#, <br />Section 'ibwmhip Range Zone Map-- water Supply:' <br /> Priva~eWell ( ) Spring <br /> Dul;th£-' Aem~ Irreg. Lot Comer Communlt5 Well ( ) City <br />Lot <br /> Wi(llb <br /> Lot <br /> <br />,3. C ontr actor~In format)~n <br /> <br /> (/I wi~ be my own g~eral contractor. <br /> <br /> ( ) i am a reglstered budder OR the au~od~d represen~ve of a registered b~der. <br /> A~chi~eC[ mine: [ Ma~g Address: ] Phone; <br /> <br />4, Fee Schedule <br /> <br />A. VALUATION (Sec "Valuation Schedule" <br /> <br /> (1) Permit Fee <br /> <br /> (2) 5% State Surcharge $05 x Al) <br /> <br /> O) Structural F'lan Review (,65% x Al) <br /> <br /> (4) Fire & Life Safety Plan Review (,40% x Al) <br /> <br /> (5) Zouing Surcharge. if applicable (,05% x Al) <br /> <br />Valilation: $ /~/~ 00' <br /> <br />(1) Driveway w/curb @ $7.30 <br /> <br />(2) Driveway w/o curb Q) $17,00 <br /> <br />(3) SitePhn Revlew l¢ommercjal only)@ $79.(X) <br /> <br />(4) Additional Plan R~views or Addendama <br /> <br />(5) IltvestigatJon Fee <br /> <br />(6) ReJnspecfion Fee @ $25,00 <br /> <br />(7) Otherlnapect[ona not listed above <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />