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MARION COUNTY BUILDING INSPECTION 220 High Stxeet NE Salem, OR 97301 8:00~rn - 4:301m~ Photo* 588-5147 Coda-A-Phone 588-7904 FAX 588-7948 BUILDING PERMIT APPLICATION COMPLETE ALL SECTIONS, 1 THROUGH 4 1. Job Description RESIDENTIAL COMMERCIAL ( ) New ........... I Use of Structure: ( )Addition ( )Rdoe,tlon ( )Addition ( )Sign V~:~Pfi~ Of Wo~: .............. ~ ~' X 2~ ' ~1 ~ll, ~l~c ~ O~ I ............ .... il il Location of Installation 3. Contractor Information ( ) I under.nd ~at I must ~s~r as a e~stmcfi~ cont~¢~ ff ~e s~mum ~ sold or offend for sam ~fom ( ) I will be my o~ g~e~al If I him subcontractors, I will him only subcontractov~ ~gistered with the C~s~on C~aao~ BIll ~ I ~ange my ~nd and 4o ~e a general contractor. I wi~ ~ntract wi~ a cmtmcmr who i$ ~$stemd wi~e Constme~ C~es B~M, ~d ~1 ~medh~y no~y Ma~ County of ~e nme of ~e c~ractoz Contnctor BusMes$ n~e & $' II ..... M~g Add~as 4. Fee Schedule A, VALUATION (See "Valaafion Schedule" to detelmine valuation based can square footage.) (1) Permit Fee ~2) 5% State Sareha~ge (.05 x Al) O) Structural Plan Review 665% x Al) (4) Fire & Life Safety Plan Review (.40% x A 1 ) (1) Driveway w/eufl~ @ $7.50 (2) Driveway w/o curb @ $1%00 (3) Site Plan Review (commercial only) @ $79.00 (4) Additional Plan Reviews or Addendmms (5) Investigation Fee (6) Reinspeetion Fee @ $25.00 Name o£ Ap;licam (Please Print)n C~J~{: ~ ~L ~L.~ Signature of Applicant: ~/~ ~ Site evaluaho~ls, septic, electrical, plumb~ 4d mechanical wo~ mq~m se~ram pe~its, MC 15-73 Rev. 11~1 l'ho.e: Bb3-" Jq[,llll Check with Marion County Bulldlng lnspellicm before suhmi~tlag this application.