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IFOR OFFICE USE ONLY MARION COUNTY BUILDING INSPECTION [FOR OFFICE USE ONLY <br />/Received By: -- 220 High Size. et NE ] city Setback Req~ti~ents: <br />[Zoning Validation: Salem, OR 97301 ]~'~,~lill{~cont: / ' Rear fi/ <br /> <br /> F~ 588-7948 ~ ~ I~ ~ .,-, <br /> ' BU~D~G PERM~ APPLICATI~ / I~:~ ,_ff~~-"~ ..... <br /> <br />RE$ID~iWf~AL COMmeRCIAL ( )New" U,e of Structure: <br />( )Addition ( )R~n ( )A~dM~ ( )Sign <br /> <br /> Aso ( )O~er ( )~ge~eu~ncy ( )O~ee ................. <br />D~c~p~on of Wo~: ~k~, <br /> ................ I ..... I ...... /0' ....... <br /> <br />2. Location of Installation <br /> <br /> q15 5 <br />Subdi~sio~ ~ ......................... ~l~k <br />~e~on TO~p ~nge Z~ Map .................... ~ater Su~ty,. <br /> ........................ pfivagW¢O ( ) Spring <br />~Wid~ %~i ~tD~ ~1 AO~S I~cg.~t Comer Commu~tyW~( ) City <br /> <br />3. Contractor Information <br /> <br />with a contractor who is registered withe Construction Contractors Board, and wiilimmediately notify Marion County of the name of the contractor, <br />ContractorBuainesanam¢&#: ' E) ~ J~W~..~ 2Z,2~to IMai~g^ddt'': IPh°ne: <br /> ~.)I am a registez~d builder OR tile authorized representative of a registered builder. <br /> <br />Mailing Addmss: ~ <br /> <br />4. Fee Schedule <br /> <br />A. VALUATION (gee "Valuation Sche.,:iule" <br /> <br /> squa~ footage,) <br /> <br /> (1) Permit F~ <br /> <br /> (2) 5% Stat~ Samha~ge (.05 x Al) <br /> <br /> (3) Structural Plan Review (,65% x Al) <br /> <br /> (4) Fire & Life Safew Plan Review (.40% x A 1) <br /> (5) Zotfing Surcharge. if applicable 605% x A 1 ) <br /> <br />B, Miscellaneous Fees ~d~ .$L 703 <br />(I) Driveway w/curb @ $7,50 <br />(2) Driveway w/o curb@ $17.00 <br />($) Sim Plan Rcxdew (commercial onky) @ $79,00 <br />(4) Additional Plan Reviews or Addendums <br />(5) hvestigatioa Fee = __ <br />(6) Reinsi~¢tion Fee @ <br />(7) Other Inspections not lis~d above __ <br /> <br /> Site evaluafi~s, septic, electrical, pl~mg ~d mechanical wo~ ~q~ serrate ~its, Check wi~ Marion Coumy B~ld~g Inspe~aion ~fo~ su~itt~g ~is apphcaron, <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />