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FO,R OFEICE USE ONL <br /> <br />I Date: . _ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Streat NE <br /> Salem, OR 97301 <br /> $:lXlam - 4:30pm Phone 588-5147 <br /> Code-A.~,bov-c 588.791M <br /> FAX <br /> BUILDING PERM1T APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 . <br /> <br /> OreCk. Use ONCV <br /> W Sett~aak <br />pront: IR~ar: <br />I L~t ~e: ~ ~g~ht Side: <br /> <br />1. job Description <br /> <br />Location <br /> <br />3. ,Contractor Information <br /> <br />I o_...~, reside in. or will reside in the completed s~ucIu~. <br /> Imdal'~land that I mUat regi~r asa ~tmcti~ ~.nxtIacwr ff the stmaure is sol~ or offered for sale befor~ or upon <br /> will b~ my ovax 8metal c~qtracwr, <br /> <br />If ~ him subcontractors, I will ~ only sobc. ontramors registered wi~ ~e Constm~on C~a~ Bmr. ff I ~ge my ~nd and do ~e a g~era} eont~ctor, I wiE ~tract <br /> <br />~ a e~t~c~r who is ~s~d wi~e C~stmcfi~ C~fs B~, ~d will ~ed~tely n~y Marion C~nty nf ~e name of ~e c~tractor. <br />Co~uacmr Bas.ess n~e & ,: I M~S Ada.ss: <br /> <br />name: ] Mailing Address: 1 Phone: <br /> <br />Fee Schedule <br /> <br />B. Miscellaneous Fees <br /> <br /> (I) Driveway w/curb@ $7,50 <br /> <br /> (2) Driveway w/o curb @ $17.00 <br /> <br /> (3) Site Plan R~view (commercial only) @ $79,00 <br /> <br /> (4) Additional Plan Reviews or A~dendums <br /> <br /> (5) Investigatic~ Fee <br /> (6) Reinsp~etioa Fee @ $25.00 <br /> (7) Other Inspections not listed above <br /> <br /> TOTAL <br /> <br />I hereby ccrfif~y that the above information is correct and that I have read and understand the Information Notice to PropeRy Owners about Construction Responsibilities on the <br /> <br /> She evaluations, septic, clcctrlcal, plumbing nod mcchanlcal work n~q~ Sgl~rat¢ pc~rtits. Check with Marion County B~lding lnspcclion bc£or~ ~ubmiUiag this application. <br /> <br />MC 15-73 Rev, 11/91 <br /> <br /> <br />