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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Sa[em, Oregon 97301 <br /> <br /> S~OOam4:3Opm Phone 588-5147 <br /> 24 hr. Impeetion Line 588-7904 <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH <br />L .iDB DESCRIPTION <br /> <br />RESIDENTIAL <br />( Addition ( ) Relocation <br />( ) Alteratkm ( ) Other <br />( ~'~cce~oey <br /> <br />COM~E~OAL ~ARION COUNTY <br />( )Addition BUILDING II~$P~'ION <br />( ) Alteration ( ) Sign <br /> <br /> ( )ChangeofOccupaney ( )Other <br /> <br />LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WI-lO IS DOING THE WORK <br /> <br /> () <br /> <br /> FEE SCHEDULE <br /> <br />A. VALUATION (See "Va/uation Schedule" to deteem~ne valuation based <br /> <br />on square footage of p/ojeot.) <br />(1) Peri,it Fee <br /> <br />(2) $% State Surcharge 605 x A I ) <br /> <br />= .~ <br /> <br />(1) AeJditional Plan Review~ or Add~ndumg = $ <br />(2) Investigation Fee <br />(3) Reinspeedoa Fe~ ~ $25.00 <br /> <br />I hereby certify ~hat the above infotmafioa is eom~et. <br />Permits are non-transferrable and exph~ if work is not sta~ed within 180 days of issuance or if work is suspended for 180 days, <br /> <br />Signature of Appllcant: Da~: <br /> <br /> <br />