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]I>~te:FOR OFFI~ig IJ~E ONLYI MARION COUNTY BUILDING INSPECTION ~ IJ~E ONLY <br />[ Receiw~_ By: ~,]/]/ 220 High Slre~t NE "Civ/Scth~.k R~qu~ ~ts ,'~ <br />IZo g V id tloi[: ,, s~, OR 97301: ' <br /> 8:~ - 4:3~ P~ 588~147 <br /> <br /> ~umn~G PERMW APPLIcATIoN <br /> CO~ ~L SEC~ONS, 1 ~OUGH 4 <br /> <br /> L Job <br /> <br />2. Lo~tion of Installation <br /> <br />3. C°nlractor l~fomation <br />l~*~,w o.~. { ~i.~ Ad~,~ ,[ Phone No: <br /> <br />( ) [ own, ~ide in, ~ vall ~ide i~ the o~nFte~d stmo~u~ <br />( ) I w~defsl~d ~ i must ~giste. r ~s a o~sUu~ico o~ra~lor if file sm~o~u~ is sokl or offe~l for male befo~ or upon o~eaplctlo~. <br /> <br />( ) Iwin~myo~o~ua~. <br /> <br />If I hire subconl~c~ors, ! will ~ o~ly subcontrac~'s fegizto~l with the Consm]o. ic~ Contxacto~ Board. If ][ change my mind and do hire a genera} cot~racvm', I will <br />with a COOLtaCtor who is l~glSt~l withe Conl t ~.i~ C~tra~s Bculrd, and v~] [,~unedinl~ly no~-y Mario¢l County of the naxlle of file contra~'~or. <br /> <br /> (~I ~ ~ ~ ~r OR ~ ~ ~ve ~ a ~g~ b~d~. ~ ~/ <br /> <br />A~.ct n~me: [.M~dlln$ Adams,: [Phone: <br />4. Fee Schedule <br /> <br />B, MitmeJla~, Fees <br /> (1) Driveway w/c~rb @ $7.50: <br /> <br /> (2) Driveway w/o curb @ $1 <br /> <br /> ~) $i~ Plan g~ (c~me~i ~ly) <br /> <br /> (4),Addi~al Plan Renews or Add~d~s <br /> <br /> ~) O~r ~s~c~ms n~ ~sted ab~ <br /> <br />I {~mby on'lily that tlmu a~w information is cor~ct and that I have read and understand file h~,~u~u. Notice to Property Owners about Cc~strucfion Responsibilities on the <br />m',,crsc sld~ of this form, , i · · <br />Nam~ of Appllf..ant OC'l~a~ Palm):'>< Phone: <br /> <br /> Site evaluations, scp~, ele~.~l, lg~nbing and mechanical work mqulm scimra~r p~mrits. Cheek with Marion County Building Inst~crion hafore ~ubmitting thi~ application. <br /> <br /> <br />