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I OR I <br /> R¢c¢iv.ed By: (~:TSL~-'/] <br /> Zoning Validation: ~ [ <br /> I . <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00~trn - 4;30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />i. Job Description <br /> <br />USE ONLY <br /> <br />2. Location of Installatlon <br /> <br />Mobile H~e Park S~ce g <br />LotWid~ ~/ ~tDCpth q~/ ACNS t.eg.~t /~0 Comer D Commm~i,.yWcU< ) City <br /> <br />3. Contractor Information <br />PmmnyOwner ,~A'~'I~ /~,nder~o~v/ {MailingAddmss jl~tlr/.~' ~-.l' P~-~Off~honeNo: <br /> (~) I own. reside ~. or will msid~ in the completed stratum. <br /> ( ) I undemtand that I mu~t register aa a construction contractor if ~¢ s~oC[~re is sold or offered £o~ sale before or upon ¢omplefio~l. <br /> <br /> ( ) I will be my own general contractor. <br /> <br />Contractor Business name & #: IMailing AddresS: [Phone'. <br /> ( ) I am a registered builder OR thc authorized repmsenlative of a registered builden <br />Architect oara : ~ [ Phone: <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> to determine valuation ba~ed on <br /> square fOOlage,) <br /> (1) Pemfit Pee <br /> <br /> (2) 5% State Surehavg= (.05 x Al) <br /> <br /> (3) Stractural Plan R~vi~w (.65% x Al) <br /> (4) Fire & Life Safety Plan Roview (.40% x Al) <br /> <br /> (1) Driveway w/curb (o~ $7.50 = __ ...... <br />Valuation: $./~¢50, ~ (2) Ddveway w/o curb @ SIT(X) = __ <br />/l~, ~ (3) Site Plan Review (comtnercial truly) @ $?9 × ~ __ <br />· ~0 (4) Additional Plan Ruviews or Addendums = <br />/,~. ~ 0 (5) Investigation Fee = __ <br /> (6) Re,spec on Fee @ $25 <br /> <br /> RECEIPT; <br /> <br />mvers¢i huruby 5enlfside o~Yt~isl/qat the above information {s correct and that I have read and undem and the Inforo at on Not Cefom~. o >roporty Owners about Constructlorl Re~, p a~b e~ on the <br /> <br /> Si~e cwduafion5, ~eptie. cle~rioal, plumbing and mechanical wo~ require serrate posits. Chc:ck w h Mar on Coun y Bu{ Jllg Inspection ~inre submiltblg ~tis application. <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />