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. FOR OF, FIC~ USE <br /> <br />[Zoning YaI~i~.~tion: : ~? <br /> Date: !l--?g,,'q~/ , <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street br~ <br /> Salem, OR 97301 <br /> <br /> 8:00ara - 4:30pm Phone 555-5147 <br /> Code-A-Phcme 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br /> <br />1. Job Description <br /> <br />RE~DENTfA L COMIVIERCIAL ( )New U~s of SmlPtum: <br />( )AddRion ( )~oaafion ( )Addifi~ ( )$~n ~ ~-~ <br /> <br /> (~AcoesS~ ( )~er ( )~g~ofOccu~ney ( )Omar <br /> <br />3. Contractor Information <br /> <br /> ( ) I own, ~ ~; or w~ msiae ~ ~ ~mp~ s~u~. ~ ~, <br /> <br /> ( ) ~ wE~ bo my own g~e~ e~t~o~ <br /> [ OV 2 11994 <br /> <br />wi~ a ¢~tmctor who is regi~md wi&e C~stmcfi~ C~ofs Bo~. and will ~meghtdy n~y Marion County of ~e name ot ~e contractor. <br /> <br /> (~ am a mglsmmd baflder OR ~c aumo~ mpms~nmfivo of a'~gism~ b~. ~ ~. d~O/4 m~ ~ ~ */ 7 J~ ~ <br /> <br /> 4. Fee Schedule <br />i A. VALUATION (S¢e "Valuatlon Schedule" <br /> <br />to d~termlne valuation based ca <br /> <br />square footage,) <br /> <br />(1) Permit Fee <br />(2) 5% State Surcharge 605 x A I) <br /> <br />¢3) StracturM Plan Review (.65% x Al) <br />(4) Fire & L/fa Safety Plan Review (,40% x Al) <br /> <br />(I) Driveway w/curb@ $7,50 <br /> <br />(2) Driveway w/o cueo @ $17.00 <br /> <br />(3) Sim Plan Review (commercial <br />(4) Additional Plan Reviews or <br /> <br />(5) ~figa~ F~ <br /> <br />(6) R~s~ofi~ P~e ~ $~,00 <br /> <br />(7) O~et ~s~c~oas not ~sted above <br /> <br />I hereby certify that the above information iS cora:ct and lhat I have tend and undet~tand the I~formation Notice to Properly Owners about Construction Respon~ib/l~ties on thc <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />