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Received ltl" /~ <br />Zoning X)ali~'atio .n(///! · <br /> //-/ff 'qJ/ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Stxv~t NE <br /> Salem, OR 97301 <br /> <br /> $;00am - 4:30pm Phone 588-5147 <br /> Cod~-A.Ph~e 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />[FOR OFFICE USE ONLY <br /> <br />RESIDENTIAL COA,RvIERCIAL ( ) New Use of Structure: O,~ <br />( )Addition ( )Re, location ( )Addilion ( )sli. /~/t~t~v/~. rl'~rT <br />( ) Demolkim ( ) Alteration ( ) Demolitioa /~ ~ o~/.5 / <br />(~ )/)iteration <br />(L.'SAccesso~y ( )other ( )Chang~ofOccupancy ( )Other <br /> <br />No Sloriasff / [ O¢¢opartt L~d or Sur~har of Empinye~$ <br />T~ss (/~ or Rafter ( ) I ' , ........................... No, Bedrooms: <br /> <br />2. Location of Il~stallatlon ~ffR/l,('g/[//,', d/,e-~ qTJ,~S-- <br /> <br />3, Contractor Information <br />Pr°Fer~yOwner %~/77~ ,, ~ ~O ~ IM~gAda~" {Ph~eNo: <br /> <br /> ( ) I undated ~at I must ress~r as a constmc5m cm~am ff me smau~ b sold or offered for sale befo~ or u~ cmplefim. ' <br /> <br /> ( ) ~ w/Il ~ my o~ g~cml contra~, <br /> <br /> OUNIY <br /> <br /> (~m a reginald builder OR ac auto~d ~pms~e of a ~gis~d ~en ~4 ]~ ~, dr ~ q 7 ~5 ~ <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "%luation Sdqedule" <br /> <br /> to demrmlae valuation based ¢m <br /> <br /> square <br /> <br /> (1) Pemk F~ <br /> <br /> (2) 5% Sate Sugha~e (.05 x Al) <br /> <br /> (3) $m]cm~l Ban Review (,~% x Al) <br /> <br /> (4) Fi~ & ~in Safety Plan Renew (,~% x Al) <br /> <br />(1) Dlivaway w/curb@ $7,50 <br /> <br />(2) Driveway wto curb @ $17,00 <br /> <br />(5) Site Plan Review (aOmmerdal only) @ $79.00 <br /> <br />(4) Additional Plan Reviews or AddendUrns <br /> <br />(5) Investigation Fed <br /> <br />(6) Reirlsgc~ca Fee @ $25.00 <br /> <br />(7) Other Inspections not listed above <br /> <br />i Itereby cea J fy thal the above information is com¢ct and that I have t~ad and undeegtand the Information Notice to Property Owners about Construction Reapon sibil.ities on the <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />