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[FOR OFFIC~ USE 9NLYI <br /> <br />[Zoning Validation: ~ I <br /> Dat~" t~.~t~ ¢- <br /> <br />MARION COUNTY ,UILDING INSPECTION ]FOR OFFICE USE OlqLY <br /> 220 High Street NE [ City $~t~cl'Req~iseme"*s: ' <br /> Salera~ OR 97301 ] <br /> <br /> BU~D~G PERM" APP~ATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH <br /> <br />1. Job Description <br /> <br /> ". __.+~,-, ~l~l'~ bULl i tT)~e of'Structure: <br /> (, ') ~dd~ox~ ( ) Relocation ( ) Addition <br /> <br /> (~5/Accessory ( )Other ( )ChmagoofO¢¢upancy ( )Other <br /> <br />.'l'm,~<[~O't~ ;rRaf~r( ) [No.S,~i~S fi/ .... {{~?mtLo~dorNu~.l~rofl~rnploy,~ <br />Squaw F~,: Baa~a'a~u { Maln Floor: ,, : {S~oand~oor: [Other: <br /> <br />Location onnstanafion <br /> <br />Su~i~ ~ BI~ <br /> Pdva~ Well ( ) Spag ( ) <br />~Wio* ~ ~ 93,,' A~s I~.'~t '~ Comet HO Commu~txw~( ) City (~' <br /> <br />Contractor Information <br /> <br /> ) Io~,m~e~,~ms~c~e~dgma~m. ' <br /> <br />wi~ a c~tm~t who ~ m~s~d ~ ~nzlmcfi~ C~c~[S B~M, and ~ ~e~a~y ~o~y Mafi~ ~nty of ~e n~c of ~e c~trac~r, <br /> <br />Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br />to det~mtine valuation I~s~d oR <br />squatg footage,) Wuaaon: $ ~O~O <br /> <br /> (3) ~ning $otcha~c, if apphcablc (-05% x Al) <br /> <br />Miace~lan~a <br />(1~ Driveway w/~urb @ $7.50 = ,~ <br />~) D~wway w/o cu~ ~ $17,~ = ~ <br /> <br />(4) Additional Plan Reviews orAdd~d~s = ~ <br />(~) ~vcs6gaa~ F~ = ,~ <br /> <br />q hereby certify ~hat thc above information is correct *ad lhat I have m~d and urld~rstaud the lnfomu~ort Notice: to Prope~y Owne~ about <br /> <br /> MC 15-73 Rev, 11/91 <br /> <br /> <br />