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FOR CITY USE ONLY <br /> R~-Ned By: <br /> Zon~g By: City:. <br /> <br />I, LOCA~ON OF ~ON <br />C~: ~qt 6~ Zip: <br /> <br />PE, R. It4F~ ~ NON- Ti~lAt$~l.~ AND ~'I~.E IF ftnOitE <br />R/Ol~ 15 Sl./~P~ND~O FOil leo ~4 Y~ <br /> <br /> CONTRACTOR INFORMATION <br />C~'a~c YUDSON"S 3[nc, <br />maflingA,~m~ 1390 13th S~. SE. <br /> <br />ci~: Salem s~: OR ~: 97309 <br /> <br />P~: 363-4141 <br />F~: 399-8760 <br /> <br />C~ ~ ~: 34604 <br /> <br /> am ~e PROPER~ O~ER ~ own. r~$~de ~ or will re~e m the <br /> <br />· ~cmre U ~old or afferent mle heart ~ u~n comp~n. <br /> <br />Con~ctorz ~d. I wat immgd~ no~ Mar~ Cogn~ of the <br /> <br />_Own~'s Sigmmre: <br /> <br />3. PLAN REVIEW SECTION <br />IMa~ea Coun~ doe~ not require a plan t~view. W~ will provide <br />plan review service if you comple~ SecUre 51] and submit two (2) <br />se~s o f pta.ns aad <br /> <br /> ~nIUON COeN'P/SUILDIWG I~SPgCrlON <br /> 31 S0 Lan3 L~0 l. Jncas~' Dr. NE - Suite C <br /> ~ ~ 97305 <br /> 8~ ~ - 4~0 ~ 24 ~. ~n L~ 373~27 F~ 58~7~8 <br /> <br /> Nu~ ofl~ ~1~ <br /> <br /> I~ C~(~) S~ <br /> I~FC~ n $tl0.~ ~ 4 <br /> <br /> L~ x S3O.~ <br /> <br /> ~1 ~ x S130.~' S , 2 <br /> <br /> ~ x S 55.~- S 2 <br />~ l~ ~tenao~ or <br /> <br /> 401 ~ <br /> <br /> D. B~nch ~ui~ <br /> ~, ~o~ or ~a Per ~el <br /> <br /> ~ M~e~neo~ (~ee or F~de~ Not <br /> <br /> Si~ C~s) ~ a L~ ~ ~ <br /> <br /> F. Each ~flo~ l~flo~ ~er ~e ~e <br /> <br /> G. Mtaor l~a ~h <br /> ~ck of lO ~$10.~ ~ <br /> <br /> 0~ ~am~ ~ag ~: ~ F~ <br /> <br />x S 50.00 - $ <br /> S <br /> <br />x $ $5.00 ~ S <br />x $ 53.00 ' $ 2 <br /> <br />x $ $S.00- S 2 <br />x S 50,00 ~ S <br />x SlO0.O0- S <br /> <br />x <br />x S .09 'S <br /> <br />S. FEES <br />Al. EntcrTo~ F~s f~m Sectkmg4 <br />A2 Add Smt~ ,'~ (,05% x Al) <br /> <br /> S .~j~' <br />SUBTOTAL: S...~5 <br /> <br />B. Enter 30%ofEneAl for Plan Ravlew <br />C. Investigation F~e, if requital <br />D. R¢inspeefion Fe~ (S$0.00) <br />E. Additional Plan ~ (62.50/hr, <br /> mhimum oae-haffhouO <br />F. lumpecdon for which no f~ ~s ~'eifi~ally }adieamd. <br /> ($6230/1u', minimum one h~u') <br />O. Inspeaion Outsi~ Norma{ Business Hou~ <br /> $62.50t]u', minimum U,vo haurs) <br />H. lndusU'iai Plant ($62.S0/hour) TOTAL AMOUNT <br /> <br /> <br />