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[FOR <br /> <br /> Received <br /> Zoning V~lida£ion:~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:30pm Phone 588-$147 <br /> Code-A-Phon~ 585-7904 <br /> FAX $88-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1, Job Description <br /> <br />,FOR OFFICE USE ONLY. <br /> <br />R~$1DI-iNTIAL COMM~RCI~AL ( ) New Use of Stmeture: <br /> <br /> 'I'~ss( ) or Rafmr( ) ~ No, Slofi~s ~ ]O¢¢upant~oadorNumb~r~ployees No, Bedrooms; <br /> <br />2. Location of Installation ,,~P///£,~-~. fff~e_~ ~9~/ <br /> <br />Subdivision Lot Bl~k <br />Section ~ To;'~;'~p e Range ~,~.,, Zme~d~t;~,'~aP WaterSo.ly: <br /> _~ FrivateWell ( ) Spring <br />i:o~Wid~dff/ LotDepth ~O/ Acres I,eg.~t ~ C727~..' CommunltyWell( ) Cily <br /> <br />3, Contractor Information <br /> <br /> ( ) I own, mslde in, or wltl m~ide in ~e completed stratum, <br /> <br /> ( ) [ Dll~f$~nd that I ~llgl ~s~r ~8 8 construction eontmemr if ~e stm~ure ix ~old or offered for sale before or ~n <br /> ( ~I will ~ my own g~teral <br /> <br />(1/] I am a registered builder OR the authorized mprusentative of a registered bu/lden <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "¥al~ation Schedule" <br /> to determine valuation based on <br /> square footage,) <br /> (l) Permit Fee <br /> <br /> (2) 5% State Surcl~arg¢ (,05 x Al) <br /> <br /> (3) Structural Plan Review (.65% x A 1) <br /> <br /> (4) Fire & Life Safety Plan Review (,40% x Al) <br /> <br />B. Miscellaneous Fees <br /> (1) Driveway w/curb@ $7,50 <br /> <br /> (2) Driveway w/o curb CC $17,00 <br /> <br /> (3) Site Plan Review (commercial c~xly) (&, $~9,00 <br /> <br /> (4) Additional Plan Reviews or Addendums <br /> <br /> (5) Investigation Fee <br /> <br /> (6) Reinqmctlon Fee (g~ $25.00 <br /> <br />RECEIPT: <br /> <br />1 horeby ¢crlil~ tha* ibc above i~ofmatloll Js cx>rrcet and ~at ~ have mad and under,mhd ~e Infommti~ Notice to Prope~y Owners about ConsLmcfion Rcsp~msibilities on ~c <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />