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[ Fi~'R OFFICE USE ONLY I MARION COUNTY BUILDING INSPECTION i"FOR OFFICE USE ONLi~ <br />IZoning Validation: ~ I [9~'~ ~ [ Salem. OR 97301 [Front: Rear: <br /> <br /> // /~ C~a-A-~ 588-7904 <br />' ' ..... ' ' . / ~ F~588-7948 <br /> ( 7Y BUmD~G ~RM~APPLICATION <br /> CO~E~ ~L SB~IONS, 1 T~OUGH 4 <br /> <br /> 1. Job Description <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br />Pml~y Owner <br /> <br />( ) I will be my ovra gmeral contractor. <br /> <br />wi* a contractor who is mg~ster*4 withe Con,,ructlo~ C~tmctor's B.~, ~d will ~odlat~y no~ ~t[ ~n~ con,racier. <br /> <br />4. Fee Schedule <br />to~emminevaluafim~sedm ~ '0 ''~. ~ (I) DdveCaywm~$7.50 <br /> <br /> (1) pemit F~ ~ '~ (~) simp)an Renew (cmme~al rely) ~ g79.~ <br /> <br />(4) Fire ~ Mie Safety Plan Review 640% x AI) : ~ <br /> <br />(4-) Ad4il~onal Plan Re'~ews oz <br /> <br />(5) ~vesfi~fi~ Fee <br /> <br />(6) Re~x~cfi~ Fee ~ $25.00 <br />~) Oq~[ ~s~efims not ~sted <br /> <br /> hereby certify that the above information is comet and that I have mad and understand the Information Notice to Propet%y Owners about Constmgtlon Responsibilities on thc <br /> <br />s,,....o,^,p,.,. _-- - '. <br /> · ~/<.., <br />Site evaluations, septic, ele~h~lumbmg a~d me~aaical wo~ ~q~m se~mte permits. Check wi~ Marion County gu[Idle Insp*ction ~fom mbmklmg ~is app~cation. <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />