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'"~OR OFFIC~ USE ONLY/ <br />IZoningValidafi°n: ff /J~' / <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8 t001trn - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 558-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />FOR OFFICE USE ONLY <br /> <br />L Job Description ~¥ 0 7 1993 <br /> <br />2. Location of lnstanation $ L: . Jf ~ /C.!~, d re q 7gcr/ <br /> <br />Subdivision Lot Bk~k <br />Section Township Range ,Zone ~[, Map Watar Supplyr <br /> .... ~ Pti~ia~Well ( ) Spriag ( ) <br /> <br />3. Contractor Information <br />p mpc r t y () w ncr .._~J F.~p3-t~e~. ~_~ <br /> <br />l, Mailmg Address I Phone No; <br /> <br />( ) I own, reside ha, or will reside in the completed stl~etute. <br /> <br />( kOr I will bo my own general contractor, <br /> <br />Contractor}tust~essnam¢&#. ~-,~_~/~ MalhngAdd~s~; .~.[,l~t~.~.ae. ~$ ~ It,one: ~J -~ /fl~ 7 ( ) I am a registered builder OR ~he au~odz~d representative of a registered b~ld~. <br /> <br />4. Fee Schedule q YgW5 <br /> <br />A. VAI.UKi'iON (See "Valuafon Schedule" <br /> to dmurmine valuation based on <br /> square footage,) <br /> (I) permit Fee <br /> <br /> (2) 5% State Sm'charge 605 x Al) <br /> <br /> (3) StcttatttrM Plan Review (,65% x Al) <br /> <br /> (4) Fire & Life $?'ety Plan Review (.40% x A 1) <br /> <br />Valuation: <br /> <br /> ~_ <br /> <br /> = <br /> <br />(I) Driveway w/cufl) (g) $7.50 = ___ <br />(2) Driveway w/o curb~l $17.(KI = ...... <br />(3) $i~e Plan Review (commercial only) (~ $79,(~ = ~ <br />(4) AddiHonal Platl Reviews or Addendmns = ..... <br />(5) '[nvest[galiml Fee = <br />¢) Reins~lion Fcc ~ $25.00 ':: .---- <br />(7) O~gr~s~ctions, 7~ not IDled above = . , ) <br /> <br /> hereby egrfify that the above itfforrnatlon ig correct ired that }f have read and understand the Information Notice to Propct%y Owncr.s about CongtmOSon Res onsibililies on the <br />reverse sklg of this form. 5r- 75'7- / /q 7 <br />>~,,,,,, o,. ^,,,,ii,d, 0,1o,,~ i,,,ha,>, _,Wf~ .,:-.~ <. ~ ~ J~ s ~ I'ho,,e: -<-7 t - r,. 0,o z <br /> <br />MC I5.73 Rev. 11/9I <br /> <br /> <br />