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IF_QROFFICE USE, O~NLY I <br />~y:~:'7':'~!3 :':/ I <br />Zoning Validation: ~:., [ <br />Dat~: ~ ~' ~'~,d'</"?"7~- ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street IVE <br /> Salem, OR 97301 <br /> <br /> 8:00am - 4;$0~m Phon~ 588-5147 <br /> C~e-A-~ 588-790~ <br /> F~ 588-7948 <br /> BU~D~G PERM~ APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 TKROUGH 4 <br />1. Job Description <br /> <br /> RE$~0ENTIAL <br /> <br /> ( ) Agdltioa ) Relocation <br /> <br />FOR ,OFFICE USE ONLY <br /> S~b~ck Requirements: <br /> <br /> tSide / Right$1de: <'"i ' <br /> <br />COMMERCIAL ( ) New <br /> <br />( ) Addition ( ) Sign <br />( ) Ahemtion ( ) Demolition <br />( )Cbm~geofOccupaney ( )Other <br /> <br />DescriptinnofWor~: .'.,~' ,',/ I:". <br /> <br /> Tm~s( ) or Rafter( ) [ No, Stories .... [O¢¢upantLoadorNum~ertffEmpinyees No, Bedrooms: <br /> <br /> ..... : "~ ~ ' 5" A , ~ 7L:~ z~ ~. ~i. ~o. 9 ~- O, h ~ ~L ~: <br /> <br /> Mo~e H~e Pa~ '.- ce ~ <br /> ]owmMp [ ~ ) Range ~) ~ ~e Map I ~ .~ Wa~rSu~iy', <br /> S~ { ' 'C' '"" r PHvateWell ( ) Spring ( ) <br />t~w'~ o ~ /~v'~ ~ ':--.~ ,,~ I~''' ~.~,,t~:.~.. ~o~ ~om~,~,yW~< > c~,~ ~ > <br /> <br />3, Coutractor Information <br /> <br />I pxopcrtyOwnnr ~-I[z5(2~-5, ~ ~.% q ~ ~ <br /> <br /> ~(~,) I own, msiflc Jg. or will ieside ui ,.he completed structure, ~-~ L 9~ . ~ Q t O J~-- q -70 ~ -7 <br /> ( ) I un&nmnd ~at I must m~stcr as a e~stmcfi~ ~tmc~ ff ~ stm~u= is soM or offered for sale before or u~n c~pled~. <br /> <br />Conttae~r BusMe~ n~e & $: l,Ma~g Address: ~ Phone; <br />Arebimet name: I Ma~g Add.ss: '[ Phone: <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (Sec "Valuation Schedule" <br /> <br /> ~quam footage.) <br /> <br /> (1) Permit Fee <br /> <br /> (2) 5% Stat~ Surcharge 605 x Al) <br /> (3) Structural Plan Review (.65% x Al) <br /> <br /> (4) P'im 86 Life Safety plan Review (.40% x Al) <br /> (5) Zoning Surcharge. if apptieable (,05% x A I ) <br /> <br />%lua,.ion; $ $~' f,',~)~'~. 0 0 <br /> <br />B. Miscellaneous Fees <br /> (1) Driveway w/curb ~ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17.00 <br /> <br /> (3) Site Plan Review (commercial only) @ $79,00 <br /> <br /> (4) Additional Plan Reviews or Adclondums <br /> <br /> (5) Investigation F~c <br /> <br /> (6) Relnspeefion Fee@ $25,00 <br /> <br />RECEiT~T: <br /> <br />Name of Applicant (I lease I OJXk'~ ' . ......... , ' q ': ...... ~ ' <br />_ , ( ~o<'it<~o~""~:' ~ v.-/,"'~i~ ,~,, )~.~--~::", <br /> Site evaluations, septic, eleafiefil,~' plumbMg ~d mechanical work tequlr¢ serrate ~its. Che~ wl~ Marion County Braiding inspection ~fom submitting ~is a~Hcafiov <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />