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FOR OFFiC/~E. U~gE 9 Uvl MARION COUNTY BUILDING ENSPECTION ~ ONLY <br /> <br />I Zomng valiaation: vG//'~ / S~em, OR 97301 <br />Da~: /~/~/~ - { 8:~- 4:3~m Phone 588-5147 '~ <br /> ] ~e-A-~588-79~,. ~; .,~;~,,~ ~ Side: <br /> <br /> BU~D~G PERM~ APPLICATI0~:~ ;, <br /> CO~LETE ~L SECTtONS, 1 T~OUGH 4 ~:~ o ~ <br /> 1. Job D~cription ~'~ <br /> <br />( ) Addjtlon ( )Relocation ( )Addition ~ '( )Sign <br /> <br />2. Location of Installation <br /> <br /> ........... <br />Me,lc ]~omc Pa~ S~ ~ <br />S~mlon %~$Mp Range Z~ Map Water Su~ly'. <br />~ Wid~ ................ ~ ~pth Ac~s I~g. ~t .... Comer ~ Pfiva~ We/I ( ) Sp~g ( ) <br /> <br />with a contractor who is registered w~tho ConsU'Uction ConLractof s Board. and will immedlat~ly notify Marion Co~mty of the name of the ccam,ctor. <br /> ( ~I am a registered belldor OR the autho~d representative of a regismred b~ilder, <br /> <br />4. ~ee Schedule <br /> <br />A, VALUATION (S== "Valuation Schedule" <br /> ~ to d~a:rmine valuation based ca <br /> <br /> squa~ footage,) <br /> (1) Permit Fc~ <br /> <br /> (2) $% State Surcharge (,05 x Al) <br /> <br /> (3) Stracthral Plan Review (,65% x Al) <br /> (4) Fire & I3fc Safely Plan Review (.40% <br /> <br /> (5) ?xming~urcharge. if applicable (.05% <br /> <br />Miscellaneous Fee~ <br /> <br />(1) Dtiv~wa¥ w&uch @ $7,50 <br /> <br />(3) $i~ Phn R~ew (c~me~i~ ~ly) ~ $79,~ <br /> <br />(4) Addi6onal Plan Reviews or Add~dms <br /> <br />(5) ~wsfiga~ Fcc <br /> <br />(6) Re~s~fim Fee ~ $25.00 <br />~) O~¢r ~S~cfims not ~smd above <br /> <br /> hereby certify that thc above i~ormation is correct and that I have read and undemand thc Information Notice o Property Owners about Constmctioq Responsibfllties on the <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />