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FOR-.oI~FIc/~ ~SE~ O.zl~..L,[ { ,~. 'UNTY BUILDING INSPECTION <br />zonigg Validation: ".,c"~' ~. [ Salem, OR 97301 <br /> <br /> MARI~ ~uu.~, · , <br />CO~ ~L S~TIONS, 1 T~m°' ~'''-'' ERM~~~ <br /> APPLICATION <br /> <br /> FOR OFFICE USE ONLY <br /> City Selback Requirements: <br />]"b~: /0 Rea~: /~ r" <br />Slde: / <br /> <br />1. Job Description <br /> <br />2. Location o£Installation <br /> <br />iflhimsubconttactors Iwillbimonlysubcontraetotg mgistcredwRhtheConxtracfionComractorsBoard LfIchangcmyml danddohircagcneralc nracor, lwillcontract <br /> <br />Contractor Bosfiaess name & #: '[ MaRing Address: <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Valuatio~ S~hedule" <br /> <br /> aquar¢ footage.) <br /> <br /> (I) Pex'mit Fcc <br /> (2) ~% State Surcharge (.05 x Al) <br /> <br /> O) Strac, turM PlC, n Review (,65% x Al) <br /> (4) Fire & Life Safety Plan Review (..40% x Al) <br /> ¢PM/~~te-Oo5% x Al) <br /> <br />B, Mi~e, ellaneou$ Fees (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17.00 <br /> <br /> 0) Site Plan Review (commemia] only)@ $79,00 <br /> <br /> (4! Additional Plan Reviews or Addcndums <br /> ($) 'hves',igailm <br /> <br /> (6) Reinspecti0n Fee @ $25.00 <br /> <br /> (7) Other Impect~ons no[ hated above <br /> <br />Nameo£Apptica,X,.(PleasePrlnt): ¥~f~S~'"~. [~t//Q,0~-,~ Phone: ~' 3/1~ <br /> <br /> Site evah,ad~ls, septic, electrical, plumbing and mechan[eal work ~Mre se~mte pe~its. Check wi~ Marion County BoildMg Impeclk)n ~fore submilt~g ~i~ application, <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />