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om%ys <br />Received By: <br />Zoning, Validation_: <br />rote: <br /> <br />MARION COUNTY BUILDING INSPECTION ~ USE ONLY <br /> 220 High Street NE [ City Setbae~k~Rcquiremcn*s; <br /> Salem, OR 97301 ~'~,~ .~* ~ I~"t~'. f~'~' ~a¢~: /V/ <br /> <br /> BUiLDiNG PERM~APPLICATIO~~ 0 9 1993 <br /> <br />COMPLETE ~L SECTIONS, 1 THROUGH 4 MARION COUNTY <br />1. Job Description BUiLDiNG INSPEC'rlON <br /> <br />RESIDENTIAL COMMERCIAL ( ) New Use of Stmctum: <br />( )Addition ( )Relocation ( )Addition ( )Sign d ~ <br />( )alm~tion ( )Demolition ( )Alteration ( )Demolition ~ti~//~¢~$'- <br />(~ccessory ( )Other ( )ChangcofOccupaacy ( )Other <br />D =ptio: o Wor : .................... <br />8,u,re Fee£: ~as[affl¢llt: I Math FioOr:llI ] Se~nd mo~: ......... [Other: J ~ ~ :il} I ' ~i~)} :liI <br /> <br />Location of Installation <br /> <br />Subdivision Lot Block <br />, , , ......... ~ommunib Well ( ) City <br /> <br />3. Contractor Information <br />PCOlm,ty Owner ~i~m~. ]j~.J' ~ ~JMa~gAddmss [PhoneNo; <br /> <br /> ( ) 1 wi~ be my own general co[~t~a,~. <br /> <br />with a contra¢iot wl~o is mgist.?:?d withe Constmctico Con t rac.~m (?._~B %¥d2~nd..~wil i immediately notify Marion County <br /> <br /> ( ) i am a rcgis~md builder OR the au~odzed representative of ~mgistemd builder. <br /> <br />Architect a ne .... ~"~ #'/'$q~. ~3' /~,~ b/4~ I Mailing Address: I Phone: <br />4. Fee Schedule <br /> <br />A1 VALUATION (See "%luation Schedule" <br /> <br /> ~quam k×*tage.) <br /> <br /> (I) Pemfit Fee <br /> <br /> (2) 5% Stole Surcharge (.05 x A 1) <br /> <br /> (3) Sm*clural Plan Review (,~% xAI) <br /> <br /> (4) Fire & Life Safety Plan Review (,40% x Al) <br /> (5~1) <br /> <br /> gl Miscellaneous I:ee~ <br /> <br /> (1) Driveway w/¢tlrb @ $7150 <br />Valuation: $~/~)~ (2) D~veway w/o cu~ SI7,(D = 1 ....... <br />~' '~ (3) Site Plan Review (c~mercJal ~ly) @ $79.(~) <br />fl, ~ (4) AddkionalPlan RevicwsorAddendum~ = 1 ....... <br />~ (5) ~vestlga,lon Fee <br /> (6) Relns~ctim Fee ~ $25.00 = __ <br />/' ~ fi) Othar lns~cti~s not listed above <br /> <br /> <br />