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OFFICE USE ONLY <br />Zoning Vali~da~.fion; ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE ~, <br /> Salem, OR 97301 ¢;i;~ <~ <br /> / 8:00am - 4:3 Phone 588-5147 <br /> <br /> FAX 588-794S <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1..lob Description <br /> <br />FOR OFFICE USE ONLY <br /> <br />2. Location of Installation <br /> <br />Mo~c Hom~ ~rk $~ ~ <br /> ' ' Pdva~We]l ( ) Spethg ( ) <br /> Co~ty Will ( <br /> City <br /> <br />3. Contractor Information <br />Proi~rty Owner 'l' ~a~ahig Address ....... i'Phonc No: <br /> <br />) I own, reside ia, or will r~side in tim c~npl~t~d stmau~. <br /> <br />) I Imderatand that I must registax as a c~astm~tlon contractor if the structure is mid or offex~d for sal~ b¢£oi~- or upon cceapleilon. <br /> <br />) I will b~ my own gt~ral aontractor, <br /> <br />If I ~ sube, ommetOrs, I will hir~ only sube~ntrac'tors registea~l with the Construction C~mtractor~ Board. If I change my mind and do hire a general contractor, I will contract <br />with a contractor who is registered withe Cor~t~yilcn~ Contractor's Boar~,~,,and willlmmediataly nefi£y Marion County of the nam~ of the contrac~r. <br /> <br /> ( ) I am a e~gistared builder OR th~ authorized relxeuentativ¢ of a regis~nxl buildea-, <br />Architect name: [ Mailing'~ddn:sS: {Phone: <br />4. Fee Schedule <br />A. VALUATION (See "Valuation Schedule" B, Miscellaneous Fees <br /> <br />(1) Permit Fca <br /> <br />(2) 5% 8tat~ Surcharge (,05 x A I) <br /> <br />O) Structural Plan Review (,65% x Al) <br /> <br />(4) Fire & Life Sdety Plan Review (,40% x Al) <br /> <br />($) 7~on/ng Surcharge. if applicable (,05% x A 1 ) <br /> <br />V~afi~:$/~.~ <br /> <br /> (1) Driveway w/curio @ $7.50 <br /> (2) Driveway w/o cuth @ $17.00 <br /> <br /> ¢~) Site Pl~ R,vlew (~ommcrd~l only) @ $79.00 <br /> <br /> (4) Additional Plan Reviews or Addeadums <br /> <br /> (5) Inv*~tigatica Fee <br /> <br /> (6) Reinspeetica Fcc @ $25,00 <br /> <br />I~EC -EIPT: <br /> <br />I hereby certify that the above information is correct md that i have r~ad ~nd understand the Information Notice to proper~y Owner~ about Conslmction Respoasibill ties on the <br />reverse side of this form. ' <br /> <br /> Site cvaluaticyas, septic, electilcal, plumbing and mechanical work mqulre seperata l~rmits, Check with Marion County I~uilding Inspection befor~ uubmittlns this application. <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />