Laserfiche WebLink
ONLY <br />Received By: <br />Zoning Validation: <br />Da~:'~ ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Sram NE <br /> Salem, OR 97~01 <br /> <br /> $~ - 4:~lm~ Photo S~-5147 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SEC,'iONS, 1 THROUGH 4 <br /> <br />1. Job mseri~fi~ <br /> <br />FOR OFFICE USE ONLY <br /> <br />Fret: R~. <br />Ld~ Side: Right Side,: <br /> <br />2. Lo~aflon of Installation ~tP~ .~*.~. ~ ' <br /> <br />3. Contractor Information <br /> <br />Owner J Mailing Address J Phone No: <br /> <br />( ) Iown, re~dein, orwiLlresldelnfl~ecompletedsm~ctme. <br /> <br />( ) I understnnd Ihat I must ~e~st~r as a oonflmcfian co~tmct~ ~f the stmauro is soM or offered for sale besom or u~on c~npletks~. <br /> <br />( ) Iwfllbemyowngenendcontract~. <br /> <br />I~ I hi~ subconwaclo~, I will hire only subcomractors mgist~ed v/ifil the C. mmxacfio~ Ce~tractors Board, If I change my mind and do ~ a g~era] conlractor, I will cc~lrac~ <br /> <br />4. Fee Schedule <br />J A. VALUATION (See "Vslu~fi~m S~hedule" B. Misce~nee~s Fees <br /> <br />m d~ermine valu~ie~ b~ed ~ <br /> <br />squ~ <br /> <br />(1) Pc~mi~ Fm <br /> <br />(2) 5% State Smcha~ge (.05 x Al) <br /> <br />0) Sl~cmral PI.~ Review (.6~ x Al ) <br />(4) Fi~ & Life Safety PI~ R~vi~w (.40% x Al) <br />(5) Zoning Sm~ha~ge, if app~cable (.05% x A 1) <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />