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FOR OFFICE USE_,_O~_~J MARION COUNTY .BUILDING INSPECTION ~F0R OFFICE uSE ONLY <br />[ZomngValidation: ~ [ lid~ S~em, OR97301 [}~: ~/ '{R,ar: <br /> BU~D~G PERM~ APPLICATION <br /> <br />2. Location of Installation ~ ] ix..l~.e.¢~ (0~- 9. '~'~ L- <br /> <br /> Contractor Information -- <br />I PmPemY Ow.er <br /> <br /> ) I ~dmmmnd ~a[ I must m~sgr <br /> <br /> ) I wffi ~ my own g~n~ <br /> <br />if I hi~ subcontmcto~,I will hi~ only aubrontra~ton TeglsI~'~d ~i~ ~ CmS~ C~ B~. H I ~ang~ my ~ an~ do ~e a g~eml cmTaaot. I wih ~ct <br />~ a c~tmc~r who is ~s~md wi~e C~tmc~ C~c~s B~ ~d~l ~e~y ~y ~ C~nty ~ ~e name ~ ~e c~tra~or. <br /> <br />Archiect n~: { Ma~g Add~m { Phone: <br /> <br />& F~e Schedule <br />A. VALUATION ($er~ "Valuation Schedule" <br /> <br /> sqqal'~ <br /> <br /> (1): permit P~ <br /> <br /> (2) 5% Sta~e Surchaqle 605 x Al) <br /> <br /> (3) SImcmral Plan R~view (fa5% x Al) <br /> (4) Fit~ & Life Safety pi, an Review (,40% x A 1) <br /> (5) Zoning Surcharge. if appllcable (.05% x Al) <br /> <br />B, Misee, llane~lS Fees <br /> <br />(1) Driveway w/curb ~ $7,50 = <br />(2) Diiveway w/o_eud>@ $17.00 <br />O) $i~ Plan Pevlew (c~ma~al ~ly) ~ $79.~ <br />(4) Addifi~ ~ Rc~ew~ Or Addmd~s = ~ <br />(5) ~vesfiga~ Fee = . .... <br /> <br />(6) ~ F~ ~ $25.~ ., ~ = ~ <br /> <br />I hereby certify that the abov~ informatloa is correct and that I hav* read and understand the Informat/xm Notice to Property Owners about Constmctlon Responsibil/fies on the <br />rever~e side of this form. t,O ~'~ ~'~ <br /> <br />Si~¢ ~vuluaticos, s~pti¢, electrical, plumbing and mechanical work rcquii~ sOFCmm p~mtits. Check with Marion County Building Iml~ction bc£om submitting this applioatlon. <br />MC 15-7.3 Rev. 11/91 <br /> <br /> <br />