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FOR O. FFIC/~_USE ~}NLY <br />[Received By: ~ <br />[Zoning Vali0ation:~ ~k~· [ <br /> <br />MARION COUNTY BUILDING INSPECTION IFOR OFFICE USE ONLY <br /> 220 High Steer NE / CAy/S~hack R~q~6r~nn~nts: <br /> / <br /> S~em, OR ~301 ~ /~ ] - /0 <br /> ' <br /> <br /> BUmD~G PERM~APPL~TI~ j 7 ~97,~ ~ <br /> <br />COMPLETE ALL SECTIONS, 1 TI-I~OUGH 4 <br />1..lob Description MARION COUN1 Y <br /> <br />2. Location ofl.stallation '~', , /{ff, tW.f # l >/ g/ <br /> <br />3. Contractor Information <br /> <br /> ( ) I un~d ~at I must ~$$t~t as a ~nstmcfi~ ~n~c~ ~ ~ s~u~ ~ sold or <br /> <br /> ( ) I wi~ ~ my o~ g~6~ <br /> <br />It I hire subcontractor% I will kin: only subcontractors m~stexed wifl~ the Construction Contractors Board, If I change my Mild and do ~ a geaeral contractor, I will contract <br />with a contractor who i$ I~gist~d with= Construotlon Contractor's BOard, and willlmmexliamly not~y Marion County of th~ nam~ of thc contractor, <br /> <br />Architect name: <br /> <br />~. Fee Schedule <br /> <br />A. VALUATION (Sca "Valuation Schedule ~ <br /> <br /> ~) 5% S=te Sumha~= (,05 x Al ) il, ~3 <br /> O) Stm~tu~ Plan Re'iow ('65% x Al)~ ~ :%7 <br /> (5) Zxmlng Sumha~¢, if a~Ecable (,05% x A I ) <br /> <br />· B. Mi$heRaneous Fe~s ' <br /> <br /> (1) Dfiwway wkur~ ~ $7,50 <br /> <br /> (2) Drivewa~ w/o curb @ $17,00 <br /> (3) Site Phn Review (commerelal e~ly)@ $79,00 <br /> <br /> (4) Addirional Plan Re~Aews or Addendums <br /> <br /> (5) Invesfigatlon Fee <br /> <br /> (~) RelnspeeUo~ Fe~@ <br /> <br /> (7) Other hspeciions notlisied above <br /> <br />I hereby certify that thc above information is correct and that I have ma~ and unders~nd the Information Notice to Pr°Peny Owners about Cc~as motion Respo~sib~ties on the <br />~vetse side of this fprm. ~ : ~ <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />