Laserfiche WebLink
Date: <br /> <br />MARI~)N COUNTY BUILDING INSPECTION <br /> ~:t/~ COMMUNITY DEVELOPMENT CENTER <br /> ~[., 285 C, hur~h St NE - Room 132 <br /> ( / ~ · Salem. Orego~ <br /> <br /> BUILDING PERMII'~AP~hlCATION %/// <br /> <br />COMPLETE ALL SECTIONS, 1 TI-~OUGH 4 <br /> <br />FOR OFFICE USE ONLY <br /> <br />City Scri~ck R~q~irexlaents:: <br /> <br />L~t 8ida:: Right Side: ~ ~ <br /> <br />Job Description <br /> <br />2. Location of Installation ~. <br /> <br />Job^ad~, ~?~ ~//~ ~ Z~. T~[,,EO C,O. S~=.~XX CX <br /> <br /> a, //,, Sa. o, . .............................. <br /> pdvateWel[ ( ) Spring <br />L,~WJdO~ ,5~ t L~Depth ~ e Ae~ ~g,,~t Comer ~X Communit) Well( ) City <br /> <br />3. Contractor Information <br /> <br />I Mailing Address { Phone No;: <br /> <br />) I own. reside in. or will reside in the completed stmctm~. <br />) I undemtand that I must register as a comtmcfien contractor ff the stmclufe is sold or offered for sale before er upon completion,, <br />) l will be my own gcneral con~m~ <br /> <br /> him ~ul-~ontractor~. I w. II lure only sub~:ontracto~ registered m~ ~c Cons~ ~acm~ B~,, H I ~ge my ~d ~d do ~re a general contractor. I ~ia mmet <br /> <br />................. ~.- .......... t Dr, .~'-ej ~n/~.~; Or~ ~7~06 <br />Architectmme,, ~t~ ~ ~ "lM~gAd'~ss:: IP~n,:: I <br /> <br />4. Fee Schedule <br /> <br />A VALUATION (See "Valuatum Schedule" <br /> <br /> tO dctenltill¢ valuation based on <br /> <br /> ¢) 5% Sure Sumba~e (05 x Al) <br /> (3) Structural Plan Revlaw (,65% x Al ) <br /> <br /> (5) /x>mng Surcha~e, ir applicable (,05% <br /> <br />B,, Miscellaneous Fees <br />(1) Driveway w/curb@ $750 = __ <br />(~) Driveway w/o curb @ $1700 = ___ <br />('3) Sate Plan Rewew (eemmereial only) @ $79,00 -- __ <br />(4) Additional Plan Renews or Addc~dums = -- <br />(5) Invesugaaon Fee = __ <br />(6) Remspeetic~ Fee@ $2500 = __ <br />C~) Other Inspections no} hated above -~ <br /> <br />M( 1%73 Re~ 8'94 <br /> <br /> <br />