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FOR OFFICE?SE ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> S,~lem. OR 97'301 <br /> <br />8 00 a.m.-4..$0 p.m. Phone588-5147 <br />Codo.A-Phone 50&7904 <br /> FAX 588-7948 <br /> <br />FOR OFFICE USE ONLY <br /> <br />COMPLETE ALL SECTIONS <br />1. Job,,D,¢$criptiOn <br /> <br />DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLICATION <br /> I THROUGH 4 <br /> <br /> A( ~ "~ '~ ~OMMERCiAL <br /> <br />2- Location of Installation <br /> <br />Septic Information (Check where applicable) <br /> <br />3_ Contractor information 5. Fee Schedules <br /> (i,lclu&~ Ei.. M~, Pi) <br /> <br />(l)Sq R.__x 28 <br />(2) 5% State Surcharge ( 05 x A 1 ) <br />(3) Bare }'ce for lq,an Review <br />(4) Zon~g Surcharge (If Apl~icablc) <br /> <br />g~htotM~ $ <br /> <br />(1) Peru-nit Pcc <br /> <br />(1) Onvewa) ~/curb @ 57 50 <br />('2) Driveway '*1o curb (a~ $17 ~ <br />(3) S~ Plan Review (c~unt, mial {m/y) ~ $79 <br /> <br />¢) Rem~ff~ Fee C~ $25 ~ <br /> <br />Valt~atlon - <br /> <br />x $40= <br /> <br /> <br />