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FOR OFFICE ~'SE ONLY I <br />Zo ng Va aa on: / <br />om: //-/'?~ ] <br /> <br />MARION COUNTY BUILDING <br /> 220 High Street NE <br /> Salem, OR 9730! <br /> <br /> Code-A-Phono 588-7904 <br /> FAX 585-7948 <br /> <br />US.~E ONLY_ <br /> <br />BUILDING PERMIT <br /> <br />COm>L~T~*LL SECT~O~qS, 1 Tm~ouo~ 4 <br /> I. Job Descri ,tion ~ ~)(~) ~ 7 <br /> <br />RE$IDF2qTIAL COMMERCIAL ( )New Uae of S~u~: <br />( )Ad~fion ( )Rel~a.~ ( )Addition ( )Sign ~e ~ <br /> ( )Almrafion ( )~oafi~ ( )Altera~n ( )~mollti~ 0F+ <br /> (~cccss~ ( )~er ( )~angcofOccupmcY ( )O~er ........ <br /> <br />Trna, ( )'"" or Raf~r ( ) I No. Ston~, l 0¢!~~nt ~a or Num~ ~ ~ployce, No. Bedrooms: <br /> <br />2. Location of Installation <br /> <br />........ ~;~, (ga. ~75~ ....... s~o. <br />Subdivision L~ ~ Bl~k <br /> <br />Se~ To~s~p Range ~e Map Wa~r Supply; <br /> ........................... PfivamWel[ ( ) Spring <br />~Wid~ i[~t ~tm~h ~[t Acma ............. I~g,~t Comer CommunliyWeB( ) City <br /> <br />3. Contractor Information ~co~ki'0.~. [~>. B3~ I,%1[ <br />P~y Owner ~ ~ ~1 Ma~g Address ~ V~& <br />~l o~, msMe ~, or w~ reside ~ ~e ~pl~mfl <br />( ) I unders~mi ~at I must ms,mr as a e~atmefim conmet~ ff ~e stratum ~ sold or offe~ for s~e befo~ or <br />( ) IwiUbemyowngmeralc~tmcto[ <br /> <br />If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor, l will contract <br />with a contractor who ia registered withe Construction Contractor's Board, &nd will/mmediately notify Marion Conmy of the name of the ¢omractor. <br /> <br />Contractor Business name & # , ~ ou. ~. Marling Address <br /> (~ I am a registered builder OR the authorized relX~S~nta[[v, of a mgi$~md builder, , , <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> to det~mzine valuation based on <br /> square footage.) <br /> (i) Permit Fee <br /> (2) 5% State Surcharge (.05 x Al) <br /> <br /> (3) Structural Plan R*view (.65% x Al) <br /> <br /> (4) Fire & Life Safely Plan Review (.40% x Al) <br /> (5) Zoning Surcbarg~, if applicable (.05% x A 1 ) <br /> <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $ IZ00 <br /> <br /> (3) Site Plan Rexdew (commercial only) @ $79.00 <br /> (4) Additional rdan Reviews or Addendurns <br /> <br /> ($) Investigation Fee <br /> <br /> (6) Re~ns~etton Fee @ $25,00 <br />,(7) Other In)pey~;ns not listed ahove <br /> <br />TOTAL <br /> <br />Site evaluations, septla, electrical, plumtin~ and mechanical work require seperate permits. Check with Marion County Building Inspection before submitting this application. <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />