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IFOR OFFICE U~I$ ONLY MARION COUNTY BUILDING INSPECTION <br /> Received'By: ~/3/~ , 220 High Street NE city Setback l~quJ~menIs: <br />Zoning Validat~n:~ ','. ~i Salem, OR 97301 ~o~t: ~ ~ ]l~ar:/~-/ <br />Date:.... t ,/I I,/¢~ ~ ~: *:O0~-c~e.A.~on,4:~ ~honeSg,_~=.~SS~-S m . =~'---S~=: .~/ ~ S~'.~/ <br />1. Job D~criptiou <br /> <br />FOR OFFIC'E USE ONLY <br /> <br />2. I~ocation of Installation <br /> <br />3. (~ontractor Iaformation <br /> <br /> (~ 0~, ~sld~ ~, ~ ~ ~side ~ ~ complet~ stm~. <br /> <br /> ( ~i~ ~ my o~ g~eml <br /> <br /> ~ I hire su~ontraotors, I w~ him only subcontracto'~ mgist~c~ ~th the Constraction Cantractom Board, H I change my n~d and do hire a general conmctor. I will contract <br /> with a contractor who is mglst~md withe ConstmcL~On Conuacto[s Board, ~md w/~l immediately notify Marion County of the name of the contra¢*or. <br />' ~;';t',,ator Business n~n¢ & #: J Maillng Addm,,: J Phone: <br /> <br /> ( ) I am a registered builder OR the authofize~ representative of a r~gister~d bulmer, <br /> <br />4. l~ee Schedule <br /> <br />A. VALUATION (See "Valuation S&cdule" <br /> t~ dctcrm~e v~ua6on ~ ca <br /> squa~ footage,) <br /> ' (~) Pc~it F~ <br />~ ~) 5%S~t¢Sum~e(,OSxAI) <br /> (~ Slmatum] ~an R=v~w (.~% n Al) <br /> (4~ Fir~ & Dfa ~fety Plan R~vi~w (.~% x Al) <br /> (5) Y~n~n~ Sumha~¢, {f applicable (-05% x A 1 ) <br /> <br />(i) Driveway w/curb @ $7.50 <br /> <br />(2) Dtiveway w/o curb@ 817,00 <br /> <br />(3) Si~e Plan Review (cc~nme~cial only)@ $79,00 <br /> <br />(4) ^a~iuonat nan ~vi~ws or Add~d~, <br /> <br />(6) R~sm~ F~ $25,~ <br /> <br />Name Of Applioant (Pleaae P~nt): <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />