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FOR O~FFICjg IJSE QNLY <br />ReceiVed By;-/J.~ ~ <br />Zoning Validation~ fi_ ~ff~ <br /> <br />MARION COUNTY BUILDING INSPECTION ]FO~"0FFICE USE ONLY <br /> <br /> Salem, OR 97301 k%~_~ .~ -.I _ t ~ ) ' Rear .... ~ / <br /> $:00am-413 Phone $88-$147 ' 0 ' ' '' ' <br /> <br /> BUILDING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1T~OUOH 4 <br /> <br /> 1. Job Oe~ription <br /> <br />( )Addillon ( )Re. loc. afl< ( )addition ( )Sign dg$~r~r ~ <br />( )Ala~rafion ( )Dexaollti~ ( )Alteration ( )Dexnolkion <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br /> ( ) I own, ~s de kn, or ~ resid~ in t~; completed stractum. <br /> ( ) I understand that i must regis~r as a constmctica contractor ff the structure is sold or offered for sale bcf0m or upon completion, <br /> <br /> ( ) ! wffi be my own gt~eral contractor. <br /> <br />If I him subcontractors, I will hire only sub¢omractor$ regist ea'e~ with ~c Cons~ Cmtracm~ B~. ff I change my ~nd and do ~re a general contract~, I wig ~tract <br />~i~ a ~m~a~r w~ i~ mgi~m~d wi~ ~n~tm~Qm ~mw~m~ Bmrd~ ~ w~ ~iam~ n~y Ma~ C~unt~ ~f ~e name ~ ~ ~t~ /~ ~ ~ ~ /~ <br /> <br /> (~ I am a regismmd b~dcr OR ~e au~od~d mpmsenmave nfa mgismmd b~der, a ....... <br />Ambient.amc:,,,,,,, .'/~.~,''-- I Ma~gAdd~ss~ ~ ~hone: <br />4. Fee Schedule <br />A, VALUA~ON (See "%laafion S~edule" B. ~scc~ane~s Fees <br /> <br />to determine valuation based on <br />square footage.) Valuation: $~.~.~ <br />(1) V~rmit Fee ~/~..~-0 <br /> <br />(I) Driveway wteu~b @ $7.50 <br />@) Driveway w/o curb @ $17.00 <br /> <br />(9) Sim Plan Review (¢ommercinl only) @ $79.00 <br /> <br />(4) Addi~onal Plan Reviews or AddcndUms <br /> <br />(5) InvesQgatk~ Fee <br /> <br />(6) ReJnspectica Fee @ 325.00 <br /> <br />(5) 7xlnthg S u~eharge, if applicable 605% x A 1 ) <br /> <br /> (7) Other Inspections not l~sted above <br /> CmlV: C 7b .B Tm: L s q/. <br /> <br />I hereby ,c?nlf}t ?,at. the above information is correct and that I have ~ad and under,tend the Information Notice to Property Owners about Ccq~strucfion Responsibilities on the <br /> <br /> Site evalualions, septic, electrical, li:m <br /> p bmg and mechanical work require scpcr~lc perm ts. Check with Marion County Building Inspection before submitting this application. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />