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IFOR oFF.[c!$ USE ONLY <br /> Rec~ive~ By:I L;Zz <br /> Zoning Validation: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> , 1 ,/ 220 High Stmet NE <br /> Salem, OR 9'7301 <br /> <br /> 8:00am - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 ~ ~ ,_e~_ <br /> FAX S$8-794S ~.~ ~:~ ~l~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 J~PR 2 ~ I~ <br />1. Job Description <br /> <br />FOR OFFICE USE ONLY <br /> <br />City S~tl~ek Reqniremon/s: <br /> <br />2. Location of Installation <br /> <br />Contractor Information <br /> <br />will be my own g~alend contractor, <br /> <br /> him snbcontractora, I will hire only subeontracmr~ mglster~ with the Construction Contractorx goa~, if I change my mind and do him a general contractor, l will contract <br />~ith a contractor who is registered withe Construction Contractor's Board, and willimmedlately notify Marion County of the name of the contractor <br /> <br /> ~ I am a regmemd boilder OR the amhonzed rcpresenJauv¢ of a regmemd builder, <br /> <br /> Fee Schedule <br /> <br />A, VALUATION (Scm "Valuation Schedule" <br /> to de~nnine v alu atD/A ba~ed ~ <br /> $quam f~g0,) <br /> (1) Pe.mit F~ <br /> (2) 5% Sm~ Su~ha~ (.05 x A 1) <br /> (3) ~m~umi Ptan K¢~icw (,65% x Al) <br /> <br /> .Y~, ~-O <br /> <br />= <br /> <br />(5) Zoning Surcharge, if applicable (,05% x Al) = <br /> <br />(1) Driveway wtcu~b~ $7.50 <br /> <br />(2) Dilveway w/o curb @ $1ZOO <br /> <br />(~) Site ~n R~'dew (eVmmemlal ~ly)~ $79,~ <br /> <br />(4) Addi~onal Plan Renews or Addcndums <br /> <br />(6) Re~s~m Fee ~ $25.00 <br /> <br />MC 15-73 Rev. 11/91 <br /> <br />Cheek web Ma6on County Building ln~ctkm before ~uhmittlng this <br /> <br /> <br />