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ceived By: J' <br />ning Validation: j/~/,~' [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />:20 Hi~ street NE <br /> Salem, OR 97301 <br /> 8:00am-4:3Opm Phone ~88-5147 <br /> Cod~-A-Hlon~ 588-7904 <br /> FAX 588-~948 <br /> <br /> FOR OFFICE USE ONLY <br />l City Selba~k R~qulrcmcnts: <br /> <br />I?sin's: 5'" t m' <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATI~ <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. Job Description <br /> (~New Single Family Dwelling wjgarag~ ( p G/Garage, aUaglled tJU[~ <br /> <br />( ) New Single Family Dwelling w/o garage ( ) Garage, detached <br /> <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />T~s$ ( ~ or Rldl~r ( ) I ~o, S,o=i~ / I Detached Oarag0 I-Ielgh~; I NO, Bedrooms: <br /> <br />2, Locationoflnsl~allation . L.~,O /t~t'~. t~£~ ~.: ~/ <br /> <br />3. Co~tractor information <br /> <br /> ( ) I own, r~id6 in, ~ will r~ide in th~ ~mplt~d <br /> <br /> mat <br /> I <br /> <br />4. Fee Schedale <br /> <br />A. New One-and-Two Family Dwelling C,~tc <br /> (inkude~ El, Me. ?1) <br /> <br /> (1) Gross Sq, Ft.~ X $28 <br /> ~) 5% State Surch~e (.05 x Al) <br /> <br /> (3) H~ Review <br /> <br />Valuation: $~.,~ (1) D~ve. wav w/cm'b @ $~.SO = __ <br /> <br /> ~) ~iwway w/o c~ ~ $17,~ ~ ..... <br /> = ~1~' ~;~ (3) ~difional ~aa Reviews or Addcndu~ <br /> ~3 (4) Investigation Fcc <br /> = ,$I85.~ (5) R¢ins~cfion Fcc ~ <br /> = ~; ~ (6) ~r Ins~efions not fist~ ~ve = ~ .... <br /> <br /> I hereby certify that the above information is o0rroct aid that I have read and understand the Inlo~mation N~cc to ~Ry Owners a~ Cons~cfion Resins b ties on Iht <br /> <br /> Site evaluations, u=p~~g and meehani=al work ~qmre *~rale ~=i=. Cheek wit, M~io. Cou.ty Building I=~ion ~fo. submJtti~ mi~ ~plicafion, <br />MC 15-g0 R~v. 1~2 <br /> <br /> <br />