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FOR OFFJ[CE USE ONLY <br />Zoning Vali~tion? ~/~ ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> S:00am - 4:30pm Phone ~88-5147 <br /> Code-A-Phone 588-7904 <br /> <br /> BUILDING ] <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />1. <br /> Job <br /> Description <br /> ,,,,,,, ~ ,- ~ ~ <br /> <br />Lc,,F, OR OFFICE USE ONLY <br /> ty Setback Reqoimment~: <br /> <br />Front: ~ ~' Rear: ~ / <br />ILeft Side' Right Side' <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br /> ~I o~, ~e ~, or wffi reside ~ ~c c~pleted atmau~. <br /> ( ) I u~d~d ~ I mu~t ~ter a~ a ~tmc~ ~r ff &e ~t~u~ i~ sold ar off¢~ for ~ale ~for~ or <br /> ( ) 1 wi~ be my om gmeml <br /> <br />B' I him subcontractors, I will hire only ~ubeontractors ~gistered with the Constm~tiot~ Contractor~ Board. If I chang* my mind and do hire a gcmeml contractor, I will contract <br />with a contra*mr who ia registered withe Construction Contractor's Board, and willimmedlatcly nc~ify Marion County of the name of the contractor, <br /> <br /> (~/~ I ama regist*r~cJ bailder OR ~1¢ authorized rcp~ese,~ltarive *fa registered build~r. <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Sehedulc" <br /> to dct~.ffnhie valuation based co <br /> square footage.) <br /> (1) Permit Fee <br /> <br /> (2) 5% Slate Surcharge (,05 x A1 ) <br /> O) Slnlctural Plan Review $65% x Al) <br /> <br /> ($) Z~h rg~.i£ applld'able (,05% <br /> <br />Valuation: <br /> <br /> I, <br /> <br />B- Miscellaneous Fees <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway wi* curb @ $17,00 <br /> <br /> ($) Site Plan Review (commercial only) @ $79.00 <br /> <br /> (4) Additional Plan Re'~ews of Addenduma <br /> <br /> (5) Investigation Fee <br /> <br /> (6) Rehi~peciloa Fee@ $25.00 <br /> <br /> (7) Oth*rlnspecilons not hsted abov~ <br /> <br />NameofAl~li,am(PleasoPrinOz.f\C~, ~5 LI~L~,(L~ .. Phot,e; ~'l'~{ <br />MC 15-'/3 Rev, 11/91 <br /> <br /> <br />