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285 Church St NE · Room 132 <br />S~lem, OR 97301 <br /> <br />Date: <br /> <br /> PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job Address <br /> <br />~. COHTRACTOR INSTALLATION ONLY <br /> <br />Mailing Add~s - <br /> <br />Property Owner (p/~sepriat) <br /> <br />CitT/Smte. tZip <br /> <br />Owner's Si~niul~: <br /> <br />I We will provide plan review service if you complete / <br />I Section 5B and submit two (2) sets of plans and [ <br />~ith this application. ~ <br />MC 1541 <br />REV 8/96 <br /> <br /> USE OF ~RU~: <br /> AL~ATION~DfflON <br /> N~ <br /> <br /> No. X F~ <br />B~ FEE <br /> <br />FORCED ~ F~ACE <br /> <br /> ~ 1~ B~ <br /> <br />Wall H~t~ $ 6.~ <br /> <br />~AT P~P <br />~r 3 Ton $ 6.50 <br />3Toned up ~ $11.~ <br /> <br />~ CO~iO~R <br /> ~r 3 Ton $ 6.~ <br /> <br /> G~ BarOque $ <br /> <br /> OAS PIPI~ 8Y~M <br /> <br /> 4 and up ~flo~ ~ omit) $ .50 <br /> <br /> ~ appl~ce p~it $ <br /> DWELLI~ ~ L~EL <br /> <br /> Al. E~r to~l offe~ f~ S~. <br /> ~l A~ 5% s~h~e (.05 x Al) <br /> ~bt~al $~ <br /> <br /> B. ~t~ 25~ of ~ Al for PI~ ~view <br /> (Al + .2~, if ~qu~ $ <br /> C. Inves~at~n F~ (if mqu~) $ <br /> <br /> R~cipt No. $~ <br /> <br /> <br />