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'i;;0R OFFICE USE ONLY <br />R~c¢ivcO'By: __ <br />Zoning Validation: <br />Da~e: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br /> BUILDING PERMIT APPLICATION <br /> <br />COM~'LETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />CE USE~ONLY <br /> <br /> Fromm; Rear: <br /> <br />1. Job Description <br /> <br />RESIDENTIAL COMMERCIAL ( ) New Use of Slmcture; <br />( )Addilion ( )Relocation ( )Addition ( )Sign <br />( ) Alteration ( )Demolition ( )Alteration ( )Demolition <br />~:.e-~Acces~o. (,(,~)O~er /' ( )ChangeofOccuDmcy .......... ( )Other <br /> <br />Truss ( ) RaCer /,,,,No, S'OdeS { Occupant Load or Number of Employees No. Bedrooms: <br /> <br />2, Loc;ition of'Installation <br /> <br />JobAdd~ ~ ~3~ ~/ =xAcct. No. Cross Street ' <br />Mob~e lime Park / Space g <br /> <br />Section qbwnship Range Zone Map Water Supply: <br /> Pdvamwell ( ) Spring <br />Lot Width lxa Depth Acres I~eg. I~t Comer Communit) Well ( ) City <br /> <br />( ) I will be my own gmera[ contracton <br /> <br />Architect name: ] Ma[llng Address: I l'honc: <br />4. Fee Schedule <br /> <br />(1) Permit Fcc <br /> <br />(2) 5% State Surcha~e (.05 X Al) <br /> <br />(3) Smlctural ISdn Review (.65% x Al) <br /> <br />(4) Fire & Life Safety Plan Review (,40% x Al) <br /> <br />(5) 7zming Surcharge, if applicable (.05% x A 1 ) <br /> <br />Valuation: $~_' <br /> <br />(1) Driveway wNurb ¢¢ S7,50 <br />(2.) Driveway w/ocurb(/~l ~17,00 <br />(3) Site Plan Review (comnlercial only) (!} $70.0(I = ...... <br />(4) Additional Phul Reviews or Addendums <br />(55 Investigation Poe <br />(6) F.¢inspecti~xl I:ee t?~ $25,00 = _ <br /> <br /> 7;:/? <br />slg..,..o,^p.,,=,t: ,,.,e, '-'- .' ? <br /> <br />MC 15-73 Rev. I1/91 <br /> <br /> <br />