Laserfiche WebLink
FO' OFnC S?J y. l. <br />Received By: ~...~ <br />IZomng Validation: ~_L_.~L¢~._~ I <br />IDate: ex9 - / 7-~95-I <br /> <br />MARiON COLrNTY BUILDING INSPECTION <br /> COMMIJNYrY DEVELOPMENT C EN'I'IgP-. <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon ~ t-.-.. ~,~ <br /> 8::OOze - 4:3 Fh ~ <br /> FAX ~85-79~ } ~ h%~ <br /> BUILDING PERMIT ~i~L[2~T~O~q~SSS <br /> <br />COMPLETE ALL SECTIONS, I THROUGH 4 <br />L Job Description MARION COUNTY <br /> <br />FOR OFFICE USE ONLY <br /> <br />2. Location of Installation ~d. /~tt~j//e gTr~. <br /> <br />3. Contractor Information <br /> <br />I Mailing Address I Phone No:; <br /> <br />( ) I o~n, reside J~, or w~ll reside in the completed stmaun~, <br /> <br />If I him subcontracton, I w,n hire only subcontractors reginerexl wi~ ~¢ Cons~on Cm~amm BtaM- If I ch~ge my ~nd and do Mre a g~eral contractor, I will mnwact <br />~ a cm~aamr who is m~smmd wi~e C~stmefi~ C~mcmfs B~Ul, ~d ~ ~ed~y n~ Mafi~ C~nty of ~c name of ~e c~tractor <br /> <br />Fee Schedule <br /> <br />I Mailing Acklress: <br /> <br />Phone <br /> <br />A, VALUATION (See 'oValuafion Schedule" <br /> <br /> (l) Permi~ <br /> <br /> (2) 5% State Surchaege (-05 x Al) <br /> <br /> O) Structural Plan Review ( 65% x A1) <br /> <br /> B.. Miscellaneous Fees <br /> <br /> (1) Driveway ~/eurb@ $7,50 <br /> <br />~' ~ (3) ~te Phn ~ew (c~me~M ~ly) ~ $79..~ = ~ <br /> <br /> (4) Addi~al Pi~ Rewews ~ Addmdms = ~ <br />~. q3 (5) ~ves~gafi~ Fcc : __ <br /> <br /> U) O~e~ ~s~c~s ~ot ~s~d a~ve <br /> <br />I hereby certify that the above itffonnatioll is correct and that I have read and underatand ~e Info~atim Notice to Pr~eRy Ownem abmt Cmstmcuon Respmsibflmes on ~e <br />Name of Applicant~~~~ea,e .n ~ Phone:: 7bF-7'L.Lzff- <br /> <br /> <br />