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FOR OFFICE USEONLY <br />Received By: {7. ¢~ /ZL~--~ <br />Zoning V~lidation: ~ ~ .'2~ _ <br />pa*e: ' ; ~ .-2- -?.~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High S~xeet NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-794g <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br /> FOR OFFICE USE ] <br /> <br />· L~t Side; 1~' , Right Sid¢i,,,,,~ "~ J <br /> <br /> RI~SiDENTIAL COMMERCIAL ( )New Use of Stw¢tu~; <br /> ( ) A~6~ ( )Rd~ ( )Addition ( )Sign <br /> <br />[,.,,,,,,~Ac~ess~ ( )~e ...... ( )~angao~ey ( )~er <br /> ....... <br /> <br /> 8auamF~t~aSe~¢nt: I ..... I , I~,: ............ ,~eight: ]~t ...... <br /> <br />z. Location of Installation <br /> <br />8uMivisi~ ~[ BI~ ' <br />' Sea/on To~s~p ~nge Z~e Map <br /> ............... ' .... Private Well ( ) <br /> <br /> 3. Contractor Information <br /> <br />I ~I own, ~side <br /> <br />( ) I tmder~tand that I must mgistaae as a o0nstnmt;oI1 ¢ontra~ot if the smmture is sold or offered for sal~ before or upon oampletion. <br /> <br />( ) I will N: my own general mntaa~or. <br /> <br />If I hire subormtractor~, I ~ l~t~ only subcontractor~ r*gis~,t~l M~ ~e Comtm~on ~tr~m~ BtaM, If I change my ~d and do hire a general contract~, I wiB ~mmct <br />wi~ a cmtmemr who ~s m~sm~d wi~e Constm~6~ Cm~ctofs Bmrd. ~d will ~dlatdy n~y MaCon County ~ ~e aa~¢ of ~e c~tracton <br /> <br /> (~ I am a regis~md builder ~e encored mpmsm~vc a ~gis~ b~den ' <br />AI~i~t name: Ma~g Address: <br /> <br />41 Fee Schedule <br /> <br />VALUATION (See"Valuation ScheduI*" <br />to det~tmlne valuation based on <br /> <br />square footage.) <br /> <br />(1) Permit Fee <br /> <br />(2) 5% Stat* Sumharge (.05 x Al) <br /> <br />(3) Structural Plan Review 665% x Al) <br /> <br />(4) Fin: & Life Safety Pla!l Review 64007o x Al) <br />(5) ZOning Surcharge, i~ applicabl~ (.05% x Al) <br /> <br />Valaation: $~ ~' <br /> <br />'B. Mimellane~s Fees <br /> (1) D~iveway w/~urb@ $7.50 ~ <br /> ('2) Driveway w/o curb @ $17.00 <br /> <br /> O) Site Plan Review (commercial only) @ $79.00 <br /> (4) AdditionaI Plan Reviews or Addendurns <br /> (5) Znve~tigation Fee <br /> (~) Rethspeetion Fee @ $25.00 <br /> <br /> (7) Othe~ Inspections not llstad above <br /> <br />I hereby certify that the aborn information is correct and that I have ~ad and understand the Information Notice o Prolmny Owneis about Con~tm¢lioa Re~ponsibilitles on the <br /> <br /> Site evaluatons, sep~c, elemfieal-- plu,~g ~dme~anlcal wo~ require serrate ~=its. Cheek wire Marion County guil0~g Impe=ion ~[o~ qubmittmg mi, appticah=, <br /> <br />MC 15-73 Rev. 11~1 <br /> <br /> <br />