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MARION COUNTY BUILDING INSPECTION Fl ICE USE ONLY <br /> 220 !-ligh Street NE ~LCky ,Setback Requirements: <br /> Salem, OR 97301 ,,.X,,~ i~"' <br /> <br /> FAX 588-7948 IJ <br /> BUILDING PERMrr APPLICAT~Yq <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 MARION COUNTY <br />1..lob Description [~lJ <br /> <br />RESIDENTIAL COI~._MERCiAL ( )NeT ..... ,~or ~,l, Structure: <br />)Addition ( )Relo~ation ( )Addition <br /> <br /> () Alteratioa ( )I'emolit'~ (~ra,ion ( )Demollti~ ~ /~ ~ <br /> ) Aceeg~c~ ( )O~er ( )~aageofOccu~n~y ( )O~er <br /> <br />'Installation <br /> <br />lob Address <br /> <br />MobiD Ilomc Park <br /> <br />Lot Widaa Lot Depth Acres <br /> <br />}Ma/ling <br /> <br />IZOne ~_... ~5~ Map Water Supply: <br />leres. PrlvaleWell ( ) Spring <br /> ~t <br /> Community Wail ( ) Cily <br /> <br />3. Contractor information <br /> <br /> ( ) !r own, reside in, or will reside in lhe completed structure. <br /> <br />Archlmc,. name: I Maili,,g Address: [Phone: <br /> <br />Fee $chedtflc <br /> <br />A. VALU^TION (8¢c "Vah~alion Schedule" <br /> <br /> (1) Permit Fee <br /> <br /> (2) 5% State &~rcharg. e (.05 x Al) <br /> <br /> (3) Slructural Plan Review (.65% x Al) <br /> <br />__ t q:,--o <br /> <br />B, Misc611aneous Fees <br />(1) Drlv*way w/curb ~} ~7.$0 :- .... <br />(2) Driveway w/o curb @ $17.~ = <br />(3) Ske Plan Review (cmmercial only)~ $79.~ = . .... <br />O) Addi~onal Plan Reviews or Addendums = ~ <br />(5) Investigation Fee = ~ <br /> <br /> (6) Rein~cfioo Fee ¢~ S2i00 I . =~-~-~ <br /> (7) O~er/sl~mcti<v~s not Iisled ~*ov~ ~'~ = ~ '. _ <br /> <br />15-73 Rev. 11/91 <br /> <br /> <br />