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F'~IR OFFICE USE ONLY <br />{Zoning Validation: ~ d~ [),- <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:00am - 4:$00m Phone 588-5147 <br /> Code-A.Phone 588-7904 <br /> FAX $88-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />'FOR"0FFICE USE 6NLY I <br /> City Setback Requi~xn~nts: <br /> <br />1. Job Description <br /> <br />Location of Installation <br /> <br />Subdivision ~t B/~k <br />Semi~n,,,,, Tomshp R~ge Zme ~t Map WatorSu~ly', <br />L~Wid~ ~Sl L~De~ q3' Acres I~g.~t Ye~ Comer ~0 PrivateWelt <)Spring<) <br /> * , Comma~tyW~ (), City ~ <br /> <br /> Contractor Information <br /> <br />~: o~, ~siae m, or ~ ~side ~ ~ completed stratum. ~ <br /> ) I wiU b~ my own gm~F~ ~tm~o* <br /> <br />4. Fee Schedule <br />A- VALUA~N (Se~ "Valua~n S~le" B, ~¢~n~s <br /> <br />sq,are footage.) <br />(1) Permit F~ <br />(2) 5% State Surchallle 005 x At) <br /> <br />(3) Structural Plan Review (,65% x A 1 ) <br />(4) Fire & Life Safety Plan Review 640% x Al) <br /> <br />(5~aiag ,~,m'ha~ i~.~pliga~ A 1 ) <br /> <br />: <br /> <br />(1) Driveway w/¢udo @ $7.50 = <br />(2) Driveway w/o su~ @ $17.00 = <br />(3) Site Plan Review (cc~mereial only) @ $79,00 = <br />(4) Addidonal Plan Reviews of Addendums <br />(5) Invcstigaric~ Fcc = <br />(6) Reinslmc~ion Fee @ $25,00 ; .., <br />(7) Other In~pestlons not Hated above = <br /> cmrr: TOT..X , $ <br /> <br />I hereby certify that the above information is o~rtest and that I have read add understand the Information Notice to Property Owners about Construction Respons bil/~es on the <br /> <br />NameofAp[~Ecant(PleasePrif)I {~llt'xa.~-I ~...Aa-~-, Fbo~e: "~lJ <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />