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FOR OF.FICE USE ONLY' <br /> Re~ived <br />I zo iog v, i a?n: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Street N~ <br /> Salem, OR 97301 <br /> <br /> 8:00m'n - 4:30pra Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> BUiLDING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. Job Description <br /> <br />2. Location of Installation <br /> <br />3, Contractor Information . , := . :: , <br /> <br /> ( )I md*~d ~at I must m~s~r as a ~t~m ~ ff ~e s~ ~ S~ off~ for s~ befor~ ~ n~n ~mplefim. <br /> ( ) I ~ ~ my om gme~ eont~or. <br /> <br />ff I ~ sub~n~. I ~ ~m rely su~ontra~ mgist~ ~ ~e C~m~on C~acm~ B~, ff I *hange my ~d and do Mre a general contractor. I wi~ ~t~ct <br /> <br />4. Fee Schedule <br /> <br /> (1) Driveway W/curb @ $7.50 <br />Valuation: SJi~J_0~~-'' ~2) Driveway w/o cu,b @ $17,00 <br />/ ' I ~-~ fO O) Site. Plan Review (commercial c~ly) @ $79.00 <br />' ~-'[ (4) Additional Phn Renews otAdd~dm~ <br /> <br /> .: (6) ~s~ Fee ~ $~.00 <br /> <br />,quam foolage.) <br /> <br />(1) permit Fee <br />(2) $% State Surcharge (.05 x Al) <br />0) Structural Plm Review (.~5% x Al) <br />{4) Fire & Life Safety Plan Review (A0% x Al) <br /> <br />(5) Zoning Sumharge. if applicable (.05% x A 1 ) <br /> <br />I hereby certify that the above information is correct and that I have read and Uttdev~nd the Informat&~rt Notice to Propeay Owners about Cons{ruCtion Responsibilities on the <br />reverse side et' this form. <br /> <br /> Ske cvalusaons, sei~clcmficah pIu~b~g ~d ~ec~c~l work ~q~ s~ ~its, Chcck wi~ Ms,on Coumy ~idie8 ~nspecfio~ ~ ~iu~ this ~pphca~o~, <br /> <br /> <br />