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FOR OFFICE USE ONLY I <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> <br /> 8:00~tm - 4:30pm Phone 588-5147 <br /> Co4~-A-Phon~ $88-7904 <br /> FAX 588-7948 <br /> BUILDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />L Job De.ri ~tion <br /> <br />City Setback Reqnjrements'. <br /> <br />Left Side: ,.,..~r~) / Right Sidc:~F.~ <br /> <br />2. Location of Installation <br /> <br />3. Contractor information <br /> <br /> (~I wi~ be my own gme~t contract~, <br /> <br />w~th a contractor who ~s r~gmer~d w~the Con~tmetmn C~,~~amly not~ Marion County of the n~ ~ ~c contractor, <br /> <br /> ) I am a mgs ~r~d budder OR the au~odz~d ~us~m~w of a mgls~md ~lder. <br /> <br /> Fee Schedule <br /> <br />A. VALUATION (See "Valuation Schedule" <br /> to determine valuation based on <br /> equate footage,) <br /> (I) pemlit Fee <br /> <br /> (2) 5o/0 State Surchazge (.05 x Al) <br /> <br /> O) Strneulral Plan Review (.65% x Al) <br /> <br /> (4) FJrt'. & l,ife Safety F[an Review (.40% x Al) <br /> <br />Valuation: $ <br /> o- o, <br /> <br />B- Miscellaaeous Fees <br /> (I) D~iveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o cu~b @ $17.00 <br /> <br /> (3) Site Plan R~vie,v (eommemhl 0nly)@ $79.00 <br /> <br /> (4) Additional Plan Reviews or Addendums <br /> <br /> (5) Investigation Fee <br /> <br /> (6) Relaspection Fee @ $25.00 <br /> <br />RECEIPT;~ (7) Ocher lqsl>cetion~mot//~'~ listed above <br /> <br /> · ' , ....... <br /> <br />i'ever~e side of fi}is form, ~ / .~0 / <br /> <br /> Site evaluations, sept}c, electrical, plumbing and mechanical wo~k require ae~ra~ pe~its, Check wkh Ma0on County Building Insp~tlio, }infect qubmitting this application <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />