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FOR OFFICE/USE ON~L~ I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:301~ Phone 588-5147 <br /> Coda-A-Phone 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I TI-IROUGH 4 <br />1. Job Description <br /> <br />RESIDENTIAL C~)MMERClAL ( ) Naw Uae of Stmctul'e: <br />( )Addition ( )R*locatloa ( )Add~tlon ( )Sign <br />(~Acce~ov/,, ( )Other ( )OtangsofOccapaney ( )Other <br />D¢;c.p.ono, wo ; 1.2 (a5 t41 , . ......... ' ..... <br />Tra~( ) or Paffter( ) I N'o-Stoti~s IOccu~mLoadorN'mmberoflSroploye~s INo, Bedroom~: ...... <br /> <br />2. Location of Installation <br /> <br /> ~.t ~, ~.,, q73~5 .,, <br />Su~ivisim ~ Bilk <br /> <br />Scion To~s~p ~g~ Z~e Map Wamr <br /> '" PdvamWell ( ) $pr~ ( ) <br />Lot Widfll <br /> <br />If I ~ subcontractors. I will hire only subcontractors registered with the Constmetlon Contractors Board, If I change my mind anti do hire a general contractor. I will contract <br />w~th a comractor who is registered withe COmtmcfion ¢ommetor'a Board, and wilIimmedlateJ¢, notify Marion County of the name of th* contractor. <br />CoatractorBusin.aanam,'&#. /"'%-..~/']-0i ~ ' '"~95& IMaillngAddmSs <br /> (X) I ism a tegmered builder O~ ~e auth~nzed rcptesent.]tlve of a ~;g]ste~l builder, <br /> <br />4,. Fee Schedule <br /> <br /> to determin~ valuatian Da s~-d on <br /> square f~otage.) <br /> <br /> (1) Permit Fee <br /> (2) 5% Stat* Surcharge (.05 x Al) <br /> <br /> (3) Stmcmntl Plan Raview (.65¢I, x Al) <br /> (4) Fire & Life Safety Plan Review (.40% x Al) <br /> <br /> Valuation: $~J~ d /~? (1) Driveway w/¢,rb @ $7.50 <br /> j$~ (2) D~veway w/o cu~ ~ $17.~ <br /> O) Site Plan Renew (c~memial rely) ~ $79,~ = ~ <br /> /'~ (4) Addi~al Plan Reviews or Add~dums = <br /> <br /> = ~ (5) ~wsfi~fi~ Fee = <br /> <br /> ; ~ (6) Re~s~c~ Fee ~ $25.00 = __ <br /> (5) ~nlng S~a~e. if applicable (.05% x A I) = ~ ~) O~er ~efions not 5st*d above <br /> <br /> Site evaluations, septic, electrical, pI~mb~and~echanical wo~ ~qui~ se~ra~ ~,s. Check wi* Marion County B~lding Inspe~i<,n ~fom at,b~itt~g ~is applt*a6on. <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />