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FOR CITY VALIDATION <br />Received by: <br /> <br />MARION COLTNTY BUILDING INSPECTION <br /> COMMUNITY Dt~VELOPMENT CENTER <br /> 255 Church St NE · Room <br /> Salem, OR 97~0t <br /> <br />24 Hr lasp~tiou Lia~. 588-7904 <br />Offle~ 588-$147 8:00 a,m. - 4:30 p.m. <br />FAX: 588.7948 <br /> <br />P/ease complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dir~tiom <br /> <br />PF.~MITS ARE NON-TRANSFER, ABLE AND EXPIKE IF WORK IS NOT <br />STARTED wrrlflN 180 DAYS OF ISSUANCE OR iF <br /> WOI~K is SUSPENDED FOR 180 DAYS, <br /> <br />FOR OWNI/R INSTALLATIONS <br /> <br />u <br /> <br />3. PLANRJEVIBW SECTION <br /> <br />Marion County does not require a plea review, <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. l~EE SCHEDULIE (Complete and egter lolal in Al b~low) <br /> <br /> R~id=mial <br /> Unit <br /> <br />I~ sq. fl, or lees ~. $85.~ . 4 <br /> <br />B. ~v~a or F~a (~ ~t inclu~ b~uch c/mu{~ s~ ae~a D) <br /> <br /> (~old only to electriaa l contraclor~) <br />H. Other <br /> (A~ ruqult~d by Bttildi~_e Ol~claO <br /> <br />$fi0.00 ~ 2 <br />St(10,fr0 __it <br />$130.00 __2 <br />$300,OO ,,, <br /> <br />$35.00 __2 <br />$40,0~ , 2 <br />$80,00., 2 <br /> <br />$ 2,00 <br /> <br />$40.00 2 <br />~0,00 ~ 2 <br /> <br />$40,00 ,, 2 <br /> <br />$35,00 <br /> <br />$50.oo __ <br /> <br />__,~/. g x $,0d = -- <br /># of Labels., _lt/C <br /> <br />FEES <br />Al, Enter total of £ecs from Sec, #4 <br />A9, Add 5% sut'=hatg~ 605 x A 1) <br /> <br />B. Enter 25% of line A I for Plan Review <br /> (Sec. 3). if required <br />C, Investigation Pe~ (if required) <br />D. Reimpe¢ tion Fac ($25.OO) <br /> <br /> TOTAL AMOUNT DIJ]~ <br />Receipt No. --,, ~ <br /> <br />$~O. Oe2 <br /> <br /> <br />