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~OROFFIC~E US? OyLYI ~ <br />IRec¢ivedBy: {~ 5~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:30pm Phone 558-5147 <br /> ~e-A-Phone $88-7904 <br /> FAX $8g-7948 <br /> <br /> BUiLDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. Job Description <br /> <br /> KBS]~DEIRTIAL COMMERCIAL ( )New Use of Structure <br /> ( ) Additi~m ( )Reloealrion ( )Ada;tim ( )Sign{.~/~t//~-f-P~r~/~ <br /> ( ) ~lt~ration ( ) Demolition ( ) Alrra'ation ( ) Demolition <br /> <br />...... (~,J/A¢~ess°rY (,.,.,!,Other ( )Chang?.~eo¢¢upancy ( )Other d~'Ha~O'~ <br /> <br /> Tress( f or Rafter( ) [ N°,Stod*~~/ / [OooupontL°ad'orNumber~Employ~s .... "Ne. Bedrooms: ...... <br />Sq.are ~}: B.~e.,: ,,[ ~ moo,: ...... ] se~a n~n Iomr; ,,?jT/)O' Height:,, /// <br /> <br /> + <br />2. Location oflnstallat/on ~{Zp/LfZ)i,//~, <br /> <br />3. Contractor Information <br />P~p~ Own,~r ff~ .~ <br /> <br /> ( )~ I undem~nd ~at I m~t re~s~t a~ a c~*tmc~ c~mr if ~* s~um ~ ~old or off~ for s~ ~fo~ or u~n c~pl~fi~, <br /> ( ) I wi~ ~ my o~ ~ ~t~or, <br /> <br />If I hire subeontractoe$, I will him only subcontcactoi~ registered with the Construe, ion CmtraetOi, Boant. If I change my mind and do hire a general contractor, I will eontracl <br />wi~h a cmtracto[who is ~gistered wi~!~ ~C-on2,m~c~, C ~Ot~r ~ of,.~, R~a~rd, and will immexliatel¥ ne~fy ~larion County of the name of the cmtraetor, <br /> <br />4. Fee Schedule <br />A. VALUA~ON (See "Vahiafim S~edul~" B. ~ac~anc~s Fees <br /> <br />to d~termlne valuation baaed on <br />square footage.) <br /> <br />(1) Permit Fee <br /> <br />(2) 5% State Surcharge 605 x Al) <br /> <br />(3) Structure]Pla Ravin (.65%xA1) <br /> <br />(5) Zoning Surcharge. if applicable (.05% x A I) <br /> <br />g ,03 <br /> <br />(1) Driveway w/curb @ $7.50 <br /> <br />(2) Driveway w/o curb @ $17.00 <br /> <br />O) Site Phn Review (e, ommemial on!y) @ $79.00 <br />(4) Additional Phn Rexdews otAddendams <br /> <br />(5) lawstigation <br />(6) Re, thspection Fe.~ @ $25,00 <br /> <br />(7) Other ~sI~¢tions not listed above <br /> <br />}eh~rcby %er t ff~y..~, at, t he abov~ information is co~¢~ and that I have read and understand the Information Notice to Property Owners about Construction Responsibiti0es on the <br /> <br /> / / <br /> Site evaluations, septic, electrical, plumbthg and meehaMcal work require sepemte permits. Check with Marion Coumy Building Impe~tion before submitting this appllcation. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />