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FOR O~,FICE U~E ONLY' <br />Zoniog Validation' ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street ~ <br /> Salem, OR 97301 <br /> <br /> $:00am - 4:30pm Phon~ 588-5147 <br /> Cod*-A-Phone 588-7904 <br /> FAX $88-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMFLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />FOR OFFICE USE ONLY <br />City Setback Re-qlfi~ements: <br /> <br />1. Job Description <br /> <br />RESIDFaNIlAL COMMF~q. CIAL ( ) New Use of Structure; <br /> ( )Rclocatlon ( )Addition ( )Si~n <br /> <br /> Tress ( ) or R~r( ~ I No. Smd~s,, /O~atLmdorNum~of~mpB~s X No, Bedrooms: <br /> <br />Location of installation <br /> <br />3. Contractor Information <br /> <br /> wffi ms~e ~ ~e cmpl,md stratum. <br /> <br /> ( ) I wiE ~ my own g~eml contma~. <br /> <br />4. Fee Schedule <br /> <br />A- VALUATfON (See "Valuation Schedule" <br /> <br /> to detormine valaation based on <br /> <br /> (l) Pemait Fe~ <br /> <br /> (2) 5% Slate Surcharge (.05 x Al) <br /> <br /> (3) Structural Plan Review (,65% x Al) <br /> <br /> (4) Fire & Life Safety Flan Review (AO% x Al) <br /> <br /> (5) 7~oning Sureha[~e, if appl/cable (.05% x Al) <br /> <br />Valuation: <br /> <br />B- Miseellaneoas Fees <br /> (I) Driveway w/curb@ $7,50 <br /> <br /> (2) Driveway w/o cu~ ~ $17.~ <br /> <br /> ~) Site Plan Redew (comme~al rely) <br /> (4) Addifi~al Hah Reqews or Addendms <br /> (5) hvesdga6~ Fee <br /> <br /> (6) R~s~cfim F~ $25.00 <br /> ~) O~er ~s~cf~s~oL~sted above <br /> <br />%verse side of this form, <br /> <br /> <br />