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MARION COUNTY BUILDING INSPECTION <br /> 22o High Street N~ <br /> Salem, OR 97301 <br /> <br /> $:00am - 4:3(¥m Phone. 58~-~147 <br /> Code-A-Phone 588-79~ <br /> F~ 588-~45 <br /> BU~D~G PERM~ APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1TI~OUGH 4 <br />1, Job Description <br /> <br />2. o atlo. or (.r. ,-do_. ¢ <br /> <br />3. Contractor Information <br /> <br /> ( ) I oma, tcs~dc in, of will rcsidc ill the ¢ompletcd ~tm~tlre, <br /> <br /> ( )~und~r~tan~that~m~str~gi~t¢rasaec~smm~nc~tra~t~r~the~tmeturc~emdf~r~ebef~re~rup~nc~mP~e~` <br /> ( ) Iw~llb~myowng~eral,onttaetor. <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuation Schedule" <br /> <br /> (l) Pe~it F~ <br /> <br /> (2) 5% Sm~ Sugha~ (.05 x Al) <br /> <br /> (3) Stmctu~l Hah Review (,~% x Al) <br /> <br /> (4) B~ & ~fe Saf~y Pla~ Revi~ (,~% x Al) <br /> <br />Valuation: $ ~l~010 <br /> <br /> = i, q3 <br /> <br />Miscellaneous Fees <br /> <br />(1) Driveway w/curb @ 87.50 <br /> <br />(g) Driveway w/o curb @ $17,00 <br /> <br />(~!. Site Plan Review (cc~nmemlal ~tiy) @ $79.00 <br />(4) Additional Plan Rexdews or Addendunis <br />(5) ~vestigafie~ Fee <br /> <br />(6) R¢inspe~fion Fee @ <br /> <br />~h~rebyccr~ifytha~thea~v¢i~rmaft~ni~rm~md~hat~have1~adandund~rstandth~n~6~nN~c¢~P~ny~wne~ab~tC~tm~ Responsibilities on thc <br /> <br /> $i~e cwluafioas, scpdc, cl~ctdcM, plurabln8 ~d ra¢¢h~nlcs! work te9~ir~ scEcr~, pennks. C~¢¢k ~i~h Marion County Bu~l,qn~ ]'nspcction t~[orc sutwaiuin~ <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />