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FOR OFFIC~ USE 9NLY <br />P~eceived By: G~f <br />{ Zoning Validation: <br />Date: / ':f/ <br /> <br />MARION COUNTY BUILDING INSPECTION ]FOR OF_FICE USE ONLY <br /> 2.?.0 High Slteet NE ,~_ I city S-bae, k Requirements: <br /> Salem, OR97301 {t~'~gi~"~,~_ [~i~: ,~ t {R~ar- ~ i <br /> <br /> F~ ~8S-794S <br /> <br /> BUILDING PERMIT APPLICA~4~i I {99~ <br />COMPLETE ALL SECTIONS · ! THROUGH 4 <br /> UARION COUNTy <br />1. Job Description R{ <br /> <br />Su~ivi~ion ~ Bt~k <br />~o~;~z. ~.Z d~ ,. s~ ~ ~ .... <br />SO.on Water <br />LotWid~ ~'}' ~De~h ~6q / A~s I~g.~/ ~ Comer ff~ PdvateWell ( ) Spring <br /> Crematory W~ ( ) C)ty <br /> <br />3. Contractor Information <br /> <br />( ) I own, reside in, or will r~side in the completed structure, <br /> <br />( ) I w{ll be my own genel'al oontracton <br /> <br />4. Fee Schedule <br /> <br />A, VALUATION (See "Vaina~.on <br /> <br />(1) Permit F~ <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />O) Structural Plan Review (.6~% x Al) <br /> <br />(4) Fire & Life Safety Plao Review 640% <br /> <br />= .,,~,,~ 3 <br /> <br />(I) Drlv~way w/curb @ $7.~0 <br /> <br />(2) Driveway w/o cut~ @ 817,00 <br /> <br />(3) Site Plan Review (commercial only) @ $79.00 <br /> <br />(4) Addirlonal Plan Re,hews or Addendums <br /> <br />(5) Investigation Fee <br /> <br />(6) Reinqmetlon Fee @ $25,00 <br /> <br />(7) Other Inspections not U~tcd above <br /> <br />TOTiL $~, 5~/ <br /> <br />N e 0£ Appli¢,nt 0>1¢ Phone: <br />,' <br /> <br />MC 15-73 Rev. 11/91 <br /> <br /> <br />