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IFOR OFFICE USE O~NLY <br /> Received By: dr~z~' ~ ~'~°'J~. I <br /> <br />lm~:L ~"~'¢~ I <br /> <br />MARION COUNTY BUILDING INSPECTION ]FO~,orric~. tJSS O Ly <br /> 220 High Sff~t ~ [ ~ty S~ ~ok Rcq~nts: <br /> S~em, OR97301 ~.m= //t {R~ar:// ' <br /> <br /> FAX 588-7948 <br /> <br /> BUll,DING PERMIT APPLICATI(~[ ] 1~3~ <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> ~ ~5:>~5) ~ ~:D mARION COUNTY <br />L Job Description <br /> <br />RESIDEN'rlAL COMMERCIAL ( <br />( )Addifi~ ( )Rd~aE~ ( )AddiSon ( )Sign <br />( ) ~raQ~ ( )Demo~fi~ ( )Altcmfi~ ( )Demohfi~ <br />,.,~ Accesso~ ( )~er ( )~gcofO~cu~ncy ( )O~cr <br /> <br />2. Location of Installation <br /> <br /> ~o,[{e: ~ q"~395 ,, si~o, , ............. <br />Su~ivision Lot <br /> <br />Mob~c Home Pa~ S~$ ~ ........ <br />Se~O~ TO~'~p ~ange ~e , Map '~ater Supply: <br />Lot"W~ 5~ La~ .......... ~ ~.~,.~[ I Co~.~ <br /> <br />3. Contractor Information <br /> 113 3,, .tt ,, Vo - zq <br /> I o~, reside ~, ~ wRl msMc ~ ~e ~ple~d stmaum, <br /> ( ) I ~dem~d ~at I must ~$smr as a ~stm~m cm~c~ ff ~e stratum is ~ or offered for sale ~om or u~ ¢mpl*6~. <br /> <br /> ( ) IMB~myo~gmc~m~ <br /> <br />~' I hire subcontractors, I will hire only subcontractors tegistere. A with ~e C~stma~ C~Wa~m B~. ff I c~nge my ~nd and do hire a gencra} contractor, I wi[~ ~ntract <br />wi~ a con.clot who ~s r¢~*tered wi~e ~nstm~fim C~tmeto[~ Bmrd, and will ~e~a~y n~y MaAon C~ty of ~e name of <br />Contractor Business n~e & ~' ( ~ O ~ <br /> (~ I am a regis e~ ~flder OR ~e un,enid m~sm~ve ora ~gts~ bmlden <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedul¢" <br /> <br /> (1) Permit Fee <br /> (:2) 5% Stem Sorcha~ge (,05 x Al) <br /> <br /> {3) Structural Plan Review (.65% x Al) <br /> <br /> (4) l"im & Life Safety Plan Review (.40% x Al) <br /> <br />I hereby eeail~,.that the above ininnnation is correct and that I have ~ad and under;tend the Information Notice to ProperLy OwnerS, about Construction Responsibilities On the <br />Nam~ of Applican; (Please Prlnt~(~ C <br /> <br /> · ' .,. p 'e, e ect' , p ~alld m nical work mqoit¢ seperate permits. Check with Marion County Building Inspection ~[ot¢ ~ubmitting this application. <br />MC 15-73 Rev. I1/91 <br /> <br />B. Miscdlaneons Fees <br /> (1) Driveway w/euth@ $7.50 <br /> <br /> (2) Driveway w/o cu~ ~ $i7.~ <br /> <br /> (3) Site Phn Renew (c~mcmial rely) <br /> <br /> (4) Additional Plan Reviews or Add~dums <br /> <br /> (5) ~vcs~gmm Fee <br /> <br /> (6) R~s~m ree~ $25,00 <br /> G) O~er ~s~ctlons not <br /> <br /> <br />