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, r>ate: .//~/q-4 , <br /> <br />MARION COUNTY BUILDING INSPECTION .[fOR OFFICE USE ONLy <br /> 220 High Street N~ ~ I~ ~ ~~ ~i~eq~kement~'. <br /> Salem, OR 97301 I~ ~ ~ ~" <br /> T I <br /> <br /> I:~ 588-7948 ' ' - <br /> <br /> BUILDING PERMIT APPLICAT~ioN <br />COMPLETE ALL SEC'nONS, ~ THROUGH 4 BUiLDiNG <br />L Job Description <br /> <br />/~'~ESiDEN,iTAL ' , ..... COMMERCIAL ....... .(., ) New Use of Structure; " <br /> <br /> ( )Alteration ( )Demolition ( )Aher~fion ( )Demolition --~ ~.~__.~ 5 <br /> ( )Accessory ( )Olher ( )ChangeofO¢¢upancy ( )OIh~r <br /> Description of Work: - -~F~ t <br /> ~l ~I~ gh - · <br /> <br />2. Location of Installation <br /> <br />3. ContractOr Information <br /> <br />( ) I own, reside in. or wilt reside in the completed structure. ~e'.~,-tfl <br /> <br />( ) l understand that ? must reg[ster a,q a construction eoBtraetor Jf the structure i,q sold or offered for sale before or uixm completlon. <br />( ) I willbe my own general CO,tractor <br /> <br />If I hire subcontractors, 1 will hire only subcontractors registered with thc Construction Contractors Board. If I change my mind and do hire a general contractor, ] will contract <br /> <br />Archilect name: ] Mailing Address: [ Phone: <br />4, Fee Schedule <br /> <br />A. VAI,UATrON (Sec "Valuation Schedule" <br /> to deLermine valuation based on <br /> square footage.) <br /> (1) I>ennit Fee <br /> <br /> (2) 5% State Sumha~e (.05 x Al) <br /> <br /> O) Structural Plan pleview (.65% x <br /> <br />...,ST*o <br /> <br />Miscellaneou~ Fee~ <br />(1) Driveway w/erich @ ,$7,50 = __ <br />(2) Driveway w/o curb @ S 17.00 = <br />(3) Sim Plan Review (commercial (rely) ~p $79,(×) = __ <br />(4) Add[donai Plan Reviews or Addendmns <br />(5) lJlvesfigalloll Fee = __ <br />(6) itelilsix~clion Fu¢ ~ S25,00 = ____ <br />(7) Odaer InspecLions not listed above = <br /> <br /> <br />