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FOR OFFICE U~E ONLY <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem OR 97301 <br /> <br />8 00 a m-4::$0 p m Phone 588-5147 <br />Code-A-Phone 588-7904 <br /> FAX 5BB-7948 <br /> <br />FOR OFFICE USE ONLY <br /> <br /> DWELLING/STRUCTURAL AND/OR SEPTIC PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />1. Job Description <br /> <br />NcEN'E[A L COMMERCIAL <br /> wSFDw/garage [ ] Accessory [ ] New I ) Sign <br />[ ] Nc~SFDw/0garagc [ ] Relocam [ ] Addiuon [ ] Demo <br />[ ~ Additim~ [ ~ ~mo I 1 Alt~rafi~ [ ~ O~hcr <br />~ ] Altcratt~l I ]~er [ ] ~angc/Occupan~ <br /> <br />LocatiOn of Instellatlon <br /> <br />3~ Contractor Information <br /> <br />Mailing Addresa & Phone No <br />Mailing &ddms~ & Phone <br /> <br /> Archit;~el Mailing Address &, Phone No <br />_,,1%1¥,,,, TD "llOo <br />4, Septic Information (Check where applicable) <br /> <br /> esl I loles Ready [] Will Call When Tes; Iloles Ready [] <br /> <br />pr,-iposcd, lm. taktatiovx Permit [] .,, ,~'" ',\, <br /> <br /> Pumpcr Form Attached -' '' ~- ' ' I i.\~''k- <br /> j f h~e read Itn~ applic,lmm ill its entirely* ~nd eerttf7 ~hat~ficC~tated mfom~ation <br /> <br />I I I agre~ build acmrding ~o ~bmkte~ an~ specifioanon~, ~e la~ of <br /> <br />Si mlture o A tea <br /> /., .. <br /> <br />5. Fee Schedules <br /> <br />D <br /> <br />(includes E]~ Me, PI) <br />(l)Sq Ft I¢;~0 ~ 28 = <br />(2) 5% State Suechargc (05 x Al) = 2~ ,~ <br />(3) Base Fcc foe Plan Review = 185 O0 <br />(4) Y~mg Surcl~trgc Of Applicable) ~ ~ ~.~ <br /> Subtotal;; <br /> <br />(Pem~il fcc dem~ined by valuation <br /> <br />(1) Pe~[t Fcc <br />(2) 5% State S~rchar~e ( 05 x B 1) <br />(3) ~nmg S~rcharge ( 05 x BI) <br />(4) Plans Check ( 65 x B1) <br /> <br />(1) Site Evalualion <br />(2) New Septic ln~Rat[~ <br />(3) Auth~tion Notice <br />(4) EXiSI~g System Rcg~ <br />(5) Major Repair <br /> Mhor Repdr (rank ~ly) <br /> <br />(1) Driveway '~/curb@ $7 50 <br />(2) Driveway ~?o curb (]~ $17l)1) <br />(3) Sim Plan Review (commercial on]~) (c~ $79 (~ <br />(4) hwestigatim Fee <br />(5) Remspecnm Fee ~ S25 O0 <br /> <br /> Total: <br /> <br />Receipt:: <br /> <br /> <br />