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I OR OmC.% ONLY <br /> R~eived By: ! vw~ <br />[ Zoning Validatign: ~2~- <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High S tt~et N~ <br />~Otl3~ Salem, OR 97301 <br /> 8:00ara - 4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> <br /> BUILDING PERMIT APPLICA~I~I$~! <br /> <br />COMPLETE ALL $I CTIONS, ! THROUGH 4 <br />2. Job V cri¢io d0£ 1 6 1995 <br /> <br /> FOR OpFICE USE ONLY"' <br />I City S~back Rcquina'aems: , <br /> <br />2. LocatiOn of Installation <br /> <br /> " ~' ' Phone No r~.~ :7£~3-76~ -d,'A~:-~ <br /> Su~ivi~ioa ~ r~4,, <br /> PfivaleWell ( ) Spriag ( ) <br /> L~Widm~/, ~ 5 LmDe~h/,~ Ac~s I~g.~t Corner Commu~tyWO(,,) City <br /> <br />3. Contractor Information <br /> <br /> (~" l win be my own g~e~ e~mtct~, <br /> <br />If [ k~ru subcontractorL I wilJ hif~ only subcontractors ggistered with tho Construction Cc~tractom Board. IfI change my mind and do kira a general contractor. I will contract <br />with a contractor who i~ iCg/stored wi0xe Con~trtw~ion ContruO. of~ Board. md will ~exliately ~c~ify Marion County of the name of th~ contractor. <br /> <br />Contractor Business name & #: J Mailing Addruss: j Phone: <br /> ( ) I am a registered builder OR the authorized reprise, n/a/lye of a mgiatercd boLlder. <br /> <br />Archi/act name: { Maii~g Address: { Fhonet <br /> <br />4. Ieee Schedule <br /> <br />A, VALUATION (See "Valnafio~a Schedule" <br />to detemline valuation based ua ~ [ ~'~ ' ~D <br />sqtlam f~mge,) Valuafim:~ <br /> (1) Pe~it F~ <br /> ~) 5% State Sumha~ (.O5 x AI) = ~ ~' ~ <br /> ~) Stmetaml lqan R~iew (,~% x AI ) = ~. ~ <br /> (4) Fit~ & Life Safety Plan Review (,~% x Al) = <br /> (5) ~ning Sutcha~e, if applicable (.05% x A I) <br /> <br />B. M/scdlanecms Fees <br /> (I) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o eutb@ $17.00 <br /> <br /> (3) Site Plan Re'dew (commercial only) <br /> <br /> (4) Additional Plan Reviews or Addeadums <br /> <br /> (5) InvesfigaUOn <br /> <br /> (6) R,inspection Fee @ $25,00 <br /> <br /> (7) Other Inspectlon s not lin/ed above <br /> <br /> heruby certify that thc above information is mrrcct and that ~ have ~ad and understand the l~formafion Notice to Property Ownem about Construction Respc~lsibilitie* on the <br /> <br /> Phone: ~ ,-?~ ~'- ~g~ ~9 <br /> <br /> Site evaluafi~a, aeptlc, electrical, plumbMg ~d me*~nical wo~ require so.cate ~ila~ Cheek wi~ Marion County Building In~pe~ion ~fo~ ~ubmltting lhia applleation, <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />