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ONLYI <br />Received By: -- 7 I <br />Zoning Vali&ation: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT C~NTER <br />285 Church St, NE - Roora 132 <br /> Salem, Oregon 97301 <br /> 8:00am - 4:30pm Phone 588-~147 <br /> Code-A-Phon~ 588-7904 <br /> FAX $88-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THI~OUGH 4 <br /> <br />2 0 1995 <br /> <br />I. Job Description <br /> <br />Location of Installation <br /> <br />3. Contractor Information <br /> <br />) [ own, realde in. or ~ reside in the complo~l stmctul~. <br /> <br />) I understand that I must mglst~r as a eon*tract;on eonll'actor if the stmctur* is soM or offend for sale before cc upon cornpletlon. <br /> <br />) I will be my own ge~leral contraclor, <br /> <br />~ Maillng Address: ~ Phone: <br /> <br />Amhlmct name: { Mailing Address: <br /> <br />Phone; <br /> <br />4. Fee Schedule <br /> ~¢V~u~~ <br /> Schedule" <br /> <br /> (1) Permit Fe~ <br /> <br /> (2) 5% State Sumha~ge (,05 x A 1) <br /> <br /> (3) $1mcmral Plan Review (,65% x Al) <br /> <br /> (4) F[r~ & Life Safety Plan Rcvie.~ (,40% x Al) <br /> <br /> (5) Zoning Surcharge. if applicable (,05% x A 1) <br /> <br />Valuation: <br /> <br />Miscemm~s <br />(1) Driveway w/¢u~b ~ $7.50 <br /> <br />~) Driveway w/o~ $17,~ <br /> <br />O) $1t~ P~ Review (c~me~ ~ly) ~ $79,~ <br />(4) Additional ~an <br />(5) hvesfi~ Fee <br />(6) ~s~c~ F~ $25.~ <br />~) O~er h*~efims not ~s~ed above <br /> <br />TOTAl. $ <br /> <br /> <br />