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FOR OFFIC~ USE ONLy <br /> <br />I Zoning Validation.~ <br /> <br /> MARION COUNTY BUILDING INSPECTION I FOR OFFICE USE ONLY <br /> /f? 220 High Street NE ~ <br /> Salem, OR97301 . ~[?~nt: ~jt5 ~ IRe**r: /O / <br /> <br /> BUmD~G PERM~ APPLff~AT~ 2 g ]9¢~ <br />CO~LE~ ~L SECTIONS, 1 T~OUGH 4 <br /> <br />1. job Description ~ARION ¢O[JN'FV <br /> <br />2. Location of Installation <br /> <br />Sub&vision L~ Bl~k <br /> CcS. .... g ..... ' ........ <br /> P~vateWell ( ) Sprig <br />LotWid~ ~51 ~ID~p~ q3i Acm, ...... Iff.g.~,~ ~mer ~V , ........... Commu~tyWe.( ) City <br /> <br />3. Contractor information <br /> <br /> ( ) I w~ ~ my om gm~ ~tra~r, <br /> <br />If I hire subcontractors, I will hire only subcontractors i~gistered with the Constra~on Contractow Board. If I change my mind and do hire a general contractor, I will contract <br /> <br />with a contractor who is registered withe Coastmetlon ¢catraaor's Board, and will immediately notify Mai/on County of the name of the ¢on~raemr. <br />Conu-~aaorBusthessnamc&#: Caoi+o~tJ~l~u, q'l~[.. Phone: -/7'J'l <br /> (~ I am a re§meted ....... builder OR the authommd mpres~ntatxv¢ of <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> <br /> (1) Permit lee <br /> <br /> (2) 5% State Surcharge (.05 x Al) <br /> <br /> (3) Structural Plan Review 665% x Al) <br /> <br />q~ 7/7 <br /> <br />B. Miscellaneous Fees <br /> <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> ~2) Driveway w/o curb @ $17.00 <br /> <br /> ('3) Site Plan Review (eommemial only) @ $79.00 <br /> (4) Additional Plan Reviews or Addeadums <br /> (5) Invesilgation Fee <br /> <br /> (6) Rethspectic~ Fee @ $25.00 <br /> <br /> (7) Other Inspeeilons noi lis~ed above <br />RECEIPT: <br /> <br />Ir ehveerersbA ~;enloft.yt h it,s tf toh~e .a b ove in~onnatiog,i~/~[$ l,mrrect and thatI have read and underStand the Information Noilce to Property Owner, abou Cons mctlo, Re,ponsibilities on the <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />