Laserfiche WebLink
F. OR OFFICE USE ONLY <br />I Rcce, ivo:t By: ~J-~ ~' ~-~ <br />~Zoning Validatiom ~'b:,ffff_: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Streot ~ <br /> Salcm, OR97301~d ~ ~ I <br /> 8:00afaCod'e4_ :A~ ~hm Pone~;;_g~ ~ <br /> <br />BU~D~G PERM~ APPLICATION <br /> <br />'FOR OFFICE USE ONLY J <br /> <br /> .,,/ <br /> <br />CO~4VL~ ~L S~CT~ONS, ~ T~mOUGH 4 MARION i30UNT¥ <br />1. Job De~rlptlon BUI~ING INSPECTJ0N <br /> <br />( )Addition ( )Rd~a~on ( )Addi~ ( )Sign <br />( )Al~on ( )Dmo~fim ( )~mra~ ( )~o"fi~ C~0~~ <br />..... (~A~sso~ ( )O&er ( )~ge~eu~n~ ( )O~er <br /> <br /> ~a,( ) ct RaUer( ) I No.$tofies [~ntL~dor~m~dEmploy~s No.B~ms: <br /> <br />2. Location of Installation <br /> <br />IobAddmss iOI4 ~$$e'~ ~l~, TaxA~t, No. <br />~v;l~e~. g~.,, ~3~ Silgo. <br />Su~ivi~ion L~ Bilk <br /> <br />Semo. To~sNp Range ~e ffM Map Water Supply':' <br />~tWid I ~tDe~ tmO, Ac~s I~g. ~t, Y~5 Comer ,,~ Commu~ty We~ ( ) City,, ~ <br /> <br />3. Contractor Information <br />PropettyOwner ~'~fS'~,l~---'~e.,4[ ~_9,~t,~.C~., IM~ungAdd~ l{>'4~e~ ~6', [Pb"~So:7~aq-77q~ <br /> <br />own, ~eside in, or will maid~ in the completed structure. <br />under~umd that ! must register as a construction o~mractor ff the stmctul~ is ~old or offered for sale before or upon completion. <br />will be my own general contractor. <br /> <br /> ·' ' .Bi ' ' ' - . If ! change my mind and do hlr¢ a general eontractog I will contract <br /> <br />~ I am a regis/e~d builder OR ~e au~o~d m~se{~e cfa ~giztemd b~d~. ~ ..... <br /> <br /> Fee Schedule <br /> ~ALUA~O~ (S~e "V~uadon $~edule" B. ~s~aneous <br /> <br />Vsquare fe~mge,) <br /> <br />(1) Permit Fee <br /> <br />(2) 5% State Sumharge (.0~5 x Al) <br /> <br />(3) Simctural Plan ~v~w (.65% x Al) <br /> <br />~ ' ' . ~ 'i~ <br />(5) 7xming Surcharge. if applicable (.05% x A <br /> <br />(1) Driveway w/cugo@ $7.50 <br /> <br />(2) Driveway w/o curb @ $17.00 <br /> <br />(3) Site Plan Review (¢ommemial only) (~ 879.00 <br /> <br />(4) Additional Plan Rev/¢ws or Addendums <br /> <br />(5) Invezllgation Fee <br /> <br />(6) Reinspeetloa Fee @ $25.00 <br /> <br />(7) Other Inspections not ~st~d above <br /> /Lc <br /> <br /> Site ovaluafions, septic, electrical, plOmbi~ a~d mechanical work r~quim ~eperate petTnlts. <br />MC 15-73 Rev. 11/91 <br /> <br />I hereby certify that the above irfformafion is correct and that I have mad and understand thc Itl fmation Notice to ProperW Ownem about Conatmctlon Responsibililles on the <br />reverse side of this form. <br />NameofApplicantCHeasePtint): ~L~'~ t~eS, &k~ke~ "5 <br />$ignatu re o f Appllcant: [j~ ~)~ Phone: 3~,3q7tl <br /> <br /> Cbeck with Marion County Building Inspection before mbmllting this application, <br /> <br /> <br />