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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Ehalem, OR 97801 <br /> <br />8:00 a.m..4:~0 p.m. Phone $88-5147 <br />Co~e-A4~hor~e 5~,7904 <br /> FAX 588-7948 <br /> <br />FOR OFFICE USE ONLY <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLICATION <br /> ;OMPLETE ALL SECTIONS, 1 THROUGH 4 <br />L Jot) DesCription <br /> <br /> ~,ESID~NT~AL COMMERCIAL <br /> [ ] NcwS~W/og~ge { ) R¢I~¢ [ ] A~ifion [ ] D~O <br /> [ ] Alteration [ ] ~r [ ] ~a~g~cupan~ <br /> <br /> U~c of gu~ldlng: ~ <br /> <br />Contractor Information 5. Fee Schedules <br /> <br />PrOperty Owner ~ailing Addre4s & Plhot~ No. <br /> ~ ~ _~ ~ ..... <br /> <br />Mailing Address & l~h~c No, <br /> <br />4. Septic Information (Check where applicable) <br /> <br />No, lie&corns: Exisl~g No, Redrooms: Ngw ~tallation [] <br /> <br />Test Ho[gs Rca4y [] Will C,xII Whea Te.~ Hol~ Rca4y ~ <br /> <br />Tank Size; <br /> <br /> have toad this appllcafi~ in i~ entirety ~d <br /> is tee and co~ ~ thc ~t o~ my ~legge. <br /> <br />O~er <br /> <br /> · e s~a~ of O~gon a~ the o~a~e~ of Ma~ ~, <br /> <br />A, New One-and.Two Fatally Dwelling Code Valuatlo,: $__ <br /> (includea ~I, Me, <br /> <br />(1) ScI. Ft.. .... x .28 <br />(2) $% State Su~chal'g¢ (,0~ x Al) <br />('3) Bas~ Fcc for Plan Review ~ 18.~.00 <br />(4) ~g ~rg~ ~ AppH~Ie) <br /> Subtotal: $ <br /> <br />Swactural ~em~it <br />(Permit f~c d~t~n'ained by valuation. <br /> El, Me, Pi am ~eparat~ ~miU.) <br /> <br />(I) Pe~it Fee <br />~) 5% $ta~ Su~hatge (.05 x BI) <br /> <br />(4) Plan~ ~ck 665 ~ BI) <br /> <br />~tie ~ (In¢lndes DEQ Sumhargc) <br />(1) Sim <br />{2) New ~M ~S~ Pe~i~ <br /> <br />(5) Major Re~air <br /> MMm R~pir (~nk ~ly) <br /> <br />Valuallon: $ <br />$~,~(~ta]~ $_ <br /> <br />(l) Driveway w/curb @ ,$7.50 <br />(2) Driveway w/o curb ~ $17,00 <br />O) $i,~ Plan Review (commerc~l only) @ $79.03 <br /> <br />(5) R~in~poefiou Fee ~ <br /> <br />Total: $~--~,, <br /> <br /> <br />