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[Receiv~t By: __ _ .,.- ~,. <br />I Zoniag Validation: _ ' <br /> <br /> CO~LE~,~L SECTIONS, 1 T~OUGH 4 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High S freer NE <br /> Salem, OR 97301 <br /> <br /> 8'-00~m - 4 ~30~m Plw~¢ 588-5147 <br /> Co~de-A q>a~ 58S-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />1. Job Descri~,fion <br /> <br /> A !a :. :,( ')Re,locan~t , ' , <br /> ~Addltloa:; ' ' " ' <br /> <br /> ( ) Acce~amy ( )O l her <br /> <br /> Location of Installation:, , <br />MeDic H~e Pa~ J S~ ¢ <br /> <br />Height: ~.~ / <br /> <br />I Block <br /> <br />Wan:r Supply: <br />privat~Well '"'"'~) Spring <br />Communlt> Well ( ) City <br /> <br />Contractor Information <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (~ee "Valuat!on. Scheclule" <br />to demnnine valuation ~sed ~ <br />squa~ f~tage,) V~uafi~: $~ <br /> <br /> (D Peril Fm. <br /> ¢) 5% Sum Sumha~e (,05 x Al) <br /> O) Stmcm~ Bm Review (,~% x A1 ) <br /> (4) Fire & ~fe Safety PI~ Review (,~% x Al) ' = ~ <br /> (5) ~ng Sut~a~e, ff ~pp~cable (.05% x Al) ~ ~ <br /> <br />(I) Dhveway w/~urb @ <br />(2) Driveway w[o curb @ $17.~ <br />(3) Si~e P~ Renew (~mer6al ~ly) <br />(4) Addifi~al Plan Rc~ew~ or A6d~dms <br />(5) ~figafi~ Fee <br />(6) Rc~ F~ ~ S25.~ = <br /> <br /> ~)'I ~I. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />