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Zaaing Validat~n. . ' I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> $:00am - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> F3X 581]-7948 <br /> <br />l FOR OFFICE USE ONLY ...] <br /> <br /> BUILDING PERMIT APPLICATI~,,~ <br />COMPLETE ALL SECTIONS, 1 THROUOH 4 <br />1. Job Description ""- ~?' ~ <br /> <br />2. Location of Installation ~ E fi/et ~-e,~, ~r~. <br /> <br />Subdivision ~ <br /> Pfivam Well ( ) Sprig ( ) <br />LotWidm ~-g Lmfi¢~ /O~t Acres i~g.~t~o Comer <br /> <br />3. Contractor Information <br /> <br /> ( ) I o~, ~side ~, or w~ ~si~e <br /> ( ~'&~nd &at I must ~ster as a ~nstm~ c~c~ ff ~e stmctu~ is sold or off, md for s~Ie ~om or u~ c~pl~. <br /> ( ) ~ wiR be my own gme~ <br /> <br />hire ~beontraO~:a3, I will hire only sobeontraetor$ ~egisterefl wi~ ~e Construction ~tr~m B~M. ~ I cMnge my ~nd and do ~c a genera} contraaor, I wi~ contract <br /> <br />4, Fee Schedule <br />A. VALUATION (Sac "Vai~ation Schedule" <br /> to &tcrmMe vduat~on ba~ed on <br /> <br /> sqtlaxo footage,) <br /> <br /> (l) p~rmit F~ <br /> <br /> (2) 5% State Surehe~e (,05 x Al) <br /> (33 St~-mmt'al plan Review (,65% x Al3. <br /> <br /> (3) Zo~dng Surcharge, if appliaab~ (,05% x Al ) <br /> <br />B. Miscellaneous Fees <br /> <br /> (1) D~iv¢x~ay w/cu~ ~ $7.50 <br /> (2) Driveway w/o e~rb @ $17,00 <br /> <br /> (3) Site Plan Review (ee,mmevelaI only) <br /> <br /> (4) Add~tlonal lYlan Review~ or Addendurns <br /> (5) lnvestigatlo~ Fee <br /> <br /> (6) Reinspeetion Fee@ $25.00 <br /> (7) Other L'x~pe~e~ion~ not l~stexl above <br /> <br /> hereby ceetffy that the above inCorma6on is comet a~d ~at I ~vc re~ and un~nd ~e ~fom~ti~ N~(~ to ~eny Owner~ a~tt C~stmc~on Rg~glb%fie~ on ~e <br /> <br /> $0c evaluations, septic, electrical, plumbing and mechanical Wo~ mqu~re sc~ra~ ~. CM~ wi& Marion Cotmty Ruitding Iusp~io~ ~[o~ ~u~ittmg ~{s app~cadon. <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />