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FOR OF LY <br />] R~eived l~y: <br />[ Zofiing VaUdation: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> ~ ~ / ~o mgh Street NE <br /> . S~, OR 97301 <br /> <br /> BUmD~G PERM~ APPLICAT~ <br /> <br />COMPLETE ALL SECTIONS, 1 TFff~OUGH 4 <br />1. Job D~cri)tion MARION COUNTY <br /> <br />2. Location oflnstallati0n <br /> <br /> , $i~ N~ ...... <br />$ub~v~ion ....... ' ~ ~""~ ~p~ "'~1~ [,~ <br />Mo~e Hmo Pa~ S~ ~ <br />Se~'"'' '1 ,TeaCUp ~ge ~'e ~e ~ Map <br />LmWid~ ~O ~ ~O~ ' Ama ~ .... ~.~t Comer Commu~yWen( ) City (~. <br /> <br />3. Contractor Information <br /> <br />( ~I,om. ~side ~, m ~ reside ~ ~e mmple~ stm~. , , ,,, <br />( ) 16n&~d ~t I must m~t~r as a ~tmefi~ ~c~r ff ~e s~um is sold or offend for s~e b~og or u~ <br />(l~i ~R ~ my own g~e~ cont~, <br /> <br />If I ~ subc~mt~ctors, I will hire only subcontractors mgis~.red with the Constru~on Ce.tractors Boa~. If I change my raind and do h/re a general contractor, J will contract <br />with a contractor who is registered withe ¢onstmalon Cmtractor's Board, and will immediately notify Marion County of the name me the coatracwr. <br /> <br />Con~xa,~'torBushaessnamc&#: La,ay :~u~-o~ 'COM~'rP, o'¢'~oMlMal/ingAddress p.~a ~¥ .~. IPhone: <br /> ( ) IamaregisteredbuilderORtheaufllofizedreprosenutiveofaregistetedbuJldev, ~'~r~o~- ~ ~" ~y]~¥~_ '~: <br /> <br />A rchlt e, ot name: I Mall/ng Addgss: I Phone: <br /> <br />4. Fee Schedule <br />'A. VA~VAT~O~ (S~;'"Wo~aon S~h~d~,.. <br /> <br /> ~o de~i~.c valuation ~as~d m <br /> <br /> (I) P~rmit Fee <br /> <br />(2) 5% Sga~e Surcharge (,05 x Al) <br /> <br />O) Structural ~n Rev~w (,~% x A1 ) <br /> <br />(4) Fire & Lif~ Safety Plan Review ( ~% x AI) <br /> <br />(5) 7x mag Su~ha~e zf app~eabl~ ( 05% x A 1) <br /> <br />V l a on $.,ll lq. oa <br /> __lj_0 3 <br /> <br />(1) DriveWay w/cure @ $7.50 <br />(2) Driveway w/o curb @ $17.00 <br /> <br />('3) Site Plan Review: (eorame~c~l only) @ $79,00 <br />(4) Additional Plan Reviews or Addendums <br /> <br />(5) Investigation F~ <br /> <br />(6) Relaspe~tieo Fee @ $25.00 <br />(7) Other ~Pe-c&olf not li~t~d above <br /> <br />MC 1~-73 Rev, 11/91 <br /> <br /> i,/~one: Q54r- ~; 793 / <br /> <br />Check with Marion ~o~oty Buildln~ hispection b~£om sub~6ng thi~ aI~Hcalloa, <br /> <br /> <br />