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FOR (J'~FICJ/.US.E~ ~W~' ~COUNTY BUILDING INSPECTION '~OR OFFICE USE.ONLY <br />Received"By: ~ ] IIll.~l g &M : 220 High Street Ni~ , [ City Setback Requireme.~: <br />ZtfiingVali~ti.o0:g g/~9~0.. [ ~ _. -Salem, OR97301.: .:: .I ~.t: lot IRear: It9 i <br /> <br /> .... , ' MARioN ' *xx $$8.?945 ' , r ~ v- - <br /> ~ PERMIT APPLICATION ~.. F~ <br />CO eL 'a s c'noss, 1 ' ' <br /> L Job DeScription , ~ ~ <br /> <br />RliSIDEAWIAL COMMFJtCIAL ., ( )New Us~, of $tm(:tum: <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> <br /> ( ) Iown,~side~.orw~side~ec~etedstm~. <br /> <br />Ifi Mm subcontractors, I will hire only subcontractoi~ n:gistered with th(: Construction Contra(:toi-~ Board, L[ I change my :rAnd and do hit(: a general contractor, I wil/contract <br />with a contractor who is i'~gistered withe Construction Contractor's Board and will im¢ediately noilly Marion COunty of the name of the contractor. <br /> <br />] Mall,~g Address: I Phone: <br /> <br />( ) I am a registered builder OR thc authorized representative of a mgistcrcti builde, r. <br /> <br />4. l~ee Schedule <br /> <br />A, VALUATION (S(:e "Valuation Schedule" <br /> <br /> square footage,) <br /> <br /> (1) Permit Fee <br /> (2) S~ st~t, Sut~ 605 x A ~) <br /> <br />g. Miscellaneous Foes <br /> <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb ~ $17.00 <br />· (3) Site Plan Review (~ommcrcial only) @ $79.00 <br /> (4) Additional Plan Reviews or Addondexns <br /> (fi) Investigation Fee <br /> (6) Reinspectlou Fee ~: $25.00 <br /> <br /> (7) Other InsFccfions not listed above <br /> <br />] he.by cc~ify that the above i~o~afiOn is ~ct ~d ~at I have mad a~d Undc~{~d ~e ~fo~atlon Noilce m Prope~y Owners about Constmc~or~ Responsibilities on ~c <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />