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220 High Street NE city <br /> Salem, OR 97301 F~ <br /> <br /> BUmDING PERM~A*mI~I~ 1995 <br />EOMPLETE ALL ~EET~ON$~ ) THROUGH 4 <br /> <br /> i. Job Descr~ptlon MARION COUNTY <br /> <br />R ~;SIDEN'IIA L COMMERCIAL <br />( ) Addldon ( ) Relocation ( ) Addition <br />( )Almrafion ( )Demulifim~ ( )Aheradon ( )Demoliti~m <br /> ( ) Accesso. ~O~er ( )Changeof~cumncy ( )Omer <br /> <br />2. Location of Installation_ <br />Properly Owner - ,,~ ~_ e~_ ~; Mail ap, Address <br /> .. , ,. .............. <br /> <br /> ............ <br />Mohffe Home Park ~ ~ ~ ~ ~[ <br />;'e'cionI %w.,h: ~ lO ~ I ~"~ ~* ~-~ I z~= ~_< ........ <br /> <br />3, Contractor Information <br /> <br />Phone So. 3 q3 --~-'~3~, <br /> <br />mo~k /6-- <br /> <br />Water Supply: <br />Private Well ( ) Spring ( ) <br /> <br />Ptope,ty Owner [ MailMg Addrea~ ] Phoae No: <br />( ) I own. mfide in, or will reside jn the compleV.-d stmcxure. <br /> <br /> (~ ! will b~ my own gcmeral contracton <br /> <br />Contrac o B sn ess name & #: I Mailing Address: lPh°ne: <br /> ( ) I am a pJgist~md builder OR the auLhorized rep~esenv~liw of a registered btdlder, <br /> <br />Archilect name: [ Mailing Address: <br />4. !Fee Schedule <br /> <br />A. VAI,UXflON (See 'T%i~)~II~[OH Schedule" <br /> <br /> (Ii Pei~nit I:~ <br /> <br /> (2) 5% State Surcharge (,05 x Al) <br /> <br /> (3) Stm¢lutal Pbn Review (.65% x A 1) <br /> <br /> (~) P'h'e & l.ife Sal'~17 Phm Review (.~% x Al) <br /> <br /> (5) 7xming Surcha~le, if appllcaMe (.05% x AI) <br /> <br />Valuation: <br /> <br />B. Mha¢e]laneous Fees <br />(I) Driveway w/¢0rb @ $7.50 <br />(2) Driveway wlo curb @ $17.(Xi <br />(3) Site Plan Review (ctxnmerc/al only) @ $79.(X) = __ <br />(4) Additional Plan Reviews or Adden&nns <br />(5) hvestigation Fee = ____ <br /> <br /> (6) Rein~ctlon Fee ~, $25.00 ~ ~ ~ ~-~k <br /> <br /> <br />