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IgOR US . O LY[ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, OR 97301 <br /> 8:00am-4:30pm PBone 58g-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br /> OFFICE USE ONLY <br /> <br />La~ft Side: ~ / ~l~ Side:~ ' <br /> <br /> ONE & TWO FAMILY DWELLING I?ERMIT APPLICATION <br /> <br />1. Job Description <br /> <br /> ( ) New Single Fmniiy Dwelling w/garag~ ( ) Garage, attached <br /> <br /> ( b,'rNew Single Fmnily Dwelling w/o garage ( ) Garage, detached <br /> <br />'i'msN ~or Rafter ( ) LN-~' Smrio'q t~ IDetached Garage l-leight: <br /> <br />No. Bedromm: <br /> <br />Square Feet; Basement: I M~noo.; J/v2 I Second ~loor: q~ [ Gan,go; <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Section ~,~ ~'~ TownsNp ~5 .... Range <br /> <br /> Si~ No. <br /> L~ Bilk <br /> <br /> Private Wdl ( ) Spring <br />X~ r~ CommunilyWdl( ) City <br /> <br />3. Contractor Information <br /> <br />If I hire subcollnactors, I will hire o y s bcon rectors regie, tec~i wifli tim Constraeqon ContraCtors B~d. If I change my ~lld aod do hire a general <br /> <br />who i~ rcgister~i wjlb file Cons~cnlon Conlractoc's B~d, I wilI immodiately notify M~on County of file Bame of ~e con~acor: <br />Contractor ~i.~ .~ & ~; ~rv.~t .... ~o ~ ~1; 6 ] ¢ .ii ~ ~/Mailing Address: .... ~l 0 W / 7~n d <br /> (~ a registered buildor OR a~e a~hori~d re~ese~afive of a regi,tered broider. ')~[~t Ore <br /> <br />4. Fee Schedule <br /> <br />A, New Onc-and-'I~o Fanfily Dwelling Code <br /> (inlcudaq Eh Me, PI) <br /> <br />Valua,,on: <br /> <br />J Midling Addre.qs: I Phone: <br /> <br />B. Miscellaneous ]gees <br /> (1) Daiveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curl) @ $17,00 <br /> <br /> (3) Additional Plan Reviews or Addendum$ <br /> <br /> (4) Inve.qtigatioll Fee <br /> <br /> (5) Reinspecfoa F~e @ $25.00 <br /> <br /> (6) Oflmr Inspections l[ot listed above <br /> <br />..... x$40= __ <br /> 'o'r^L * 7_ R. <br /> <br /> i' !,el'el}y 5:fftify.?~at~. he almve i,fl-ormatlon is correct a.d that I have re~ and understood the Informati. f~,ff)Notice to Property Owners about Cousin ctio <br /> <br /> .... ~ ~, ~ ,,~ ~/ ~ '~ Vho.~: <br /> S e eva ua one qe~nnd mechanlcal~k re rare se role ~ <br />MC t5-80 Rev, <br /> <br /> <br />