Laserfiche WebLink
OmCCC. SE O LY <br />¢cekved By:,~~' <br />oning Va?atiom/~ <br />Date: _~ ~/ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:3~pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I TI[ROUGH 4 <br /> <br />FOR OFFICE USE ONLY <br /> <br />I. Job Description <br /> <br />REglI)~qTIAL CO1VLMI~RCIAL ( )New Use of Stmcm~; ..... x~ ,, ~ ..... <br /> <br /> ( )AddMo~ ( )~a~ ( )Ad~6~ ( )S~. C~g~gT MARION COUNTY <br /> ( )~ ( )~o~ ( )A~ ( )D~ou~ BUILDING INSPECT{0I <br /> ~Ac~as~ ( )~er ( )~geofOem~ncy ( )O~er <br /> <br />2. Location of Installation <br /> <br />Subdlvlsic~ Lo~ Bl~k <br />Scion To~s~p ~nge Z~e Map Wa~t Su~ly: <br />Lot Wid~ i O~ ?, ...................... Lot ~h q ~' Acm, ~eg. ~t Comer Commu~ty W~ (, City <br /> <br />3. Contractor Information <br /> <br />-~1 am a registered builder OR 0ac authorized ~ep~csc[tativc of a registered buildcr, t <br />Amhlteetname:Add **; ...... <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br />[o determine valuation based on <br />squa, e footage.) Valuation: $ ~/a, <br /> <br /> (2) ~% st~t~ S~r~a~ (.OS x A~) = /, 5'.9 <br /> (5) 7xmthg Surcharge, if applicchle (.05% x Al) <br /> <br />B, Miacellaneoas Fees <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17,00 <br /> <br /> (3) $].!~ I~lail ReView (cmmer~ ~ly) ~ $79,~ <br /> <br /> (4) Additional Plan Renews or Add~dm~s <br /> <br /> (5) ~vesfigafi~ Fee <br /> <br /> (6) Re~s~cd~ Fee ~ S25,00 <br /> G) Other ~s~ot ~smd a~v¢ <br /> <br />I hereby ceaify that the above infonnafioj~s conect and that I have read and understand the I~formation Notice to Property Owners about Construction Responsibilities o~ the <br /> <br /> $ile cvaluatioos, septic, el~ctri¢~l, p~m~g ~tttl m~¢bmical work requir~ Sel~rate permits, Cba~k with Marion County Building Inspe~ion before mbmitting this application. <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />