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I FOR. 'bFFI:~C~E~U,~SE,~N~Y MARION COUNTY B~D~G ~SPECTION <br /> 5~m, OR 97301 <br /> <br /> v ouo 4 9 1995 <br /> L Job D~cripfi~ <br /> <br />2. Location of Installation ~-~%g~_ <br /> <br />Subdivision Lo~ Bilk <br />Se~n To~s~p ~ge ~e ~p Wa~r <br /> ....... Pdva~ Wall ( ) Sp~g ~.~. <br />~Wid~ ~ ~ms ~g.~ ...... Comer C~mo~t)'W~( ) City <br /> <br />3. Contractor Information <br /> Owner { Mailing Addre~z [ phone No: <br />Prot~r~y <br /> <br />own, mslde in, or will re~fle in file completed stmaum, <br />underhand lhat I must register as a coustmctloo ~ontraclor if file smlaure is sold or offered for sale before or upon completion, <br />will be my own general cemraetc~. <br /> <br />If I ~ sub~onu~ctors. I will him only subcontractors r~gistercd ~ ~e ~ ~cto~ B~, ff I ~nge my ~d ned do ~e a general ¢onttact~, I will ~ntract <br />~ a c~c~r who is ~s~d wi~e ~stmcfi~ C~tmc~f~ B~ ~d ~1 ~y ~y Ma~ ~nty of ~ ~ ~e ¢~tracwr, <br /> <br /> ( ) I am a r~gismmd b~d~r OR ~e ~o~d ~s~fiv¢ ~ a ggisg~ ~, <br /> <br />Archlt~ct name: · I Maaing ~a~.: {Phone: <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION(See Valuation Schedule <br /> <br /> square footage,) <br /> <br /> (1) Permit F~ <br /> <br /> (2) 5% SLate Sumhaqte (.05 x Al) <br /> <br /> ~3) Structural Plan Ravicw (.65% x Al ) <br /> <br /> (4) Fire & Life Safety Plan Review (A0% x Al) <br /> (5) Zoning Surcharge, il- applicable ( 05% x A 1 ) <br /> <br />B, M~eell:~e, on~ Fe~s <br />(I) Driveway w/curb@ $7,50 = -- <br />(2) Dfivewayw/ocurb@ $17,00 = __ <br />O) Si~ ~an Renew (c~me~i~ ~ly) ~ $79.~ = __ <br />O) Addifi~al Plan Renews or Addmdms = ~ <br />(5) hws6gafim F~ = ~ <br />(6) Rms~6~ Fee ~ $25.00 = <br /> <br />I hereby certify that the above informatiOn is correct and filat I have read and undersland file lnformatlon Notice to Property Ownem about Constmcfion Responsibilities on the <br />mverae side of this form. <br /> <br /> Site evaluations, septic, e~"'c~fical, plumbing and mechaineal work requir~ s¢l~ral~ pelmits. Cheek with Madoa County Building Impeetion before sulanlttlng this application, <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />