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IFOR"OFFICE USE ONLY <br /> Received By: ' <br /> oning Validation: : <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 22O High Su~eet NE <br /> Salem, OR 97301 <br /> $:00am-4:$0pm Pheme. 588-$147 <br /> Code-A-Phon~ 588-7904 <br /> FAX 588-7948 <br /> <br />ONE & TWO FAMILY DVOgLLING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JobDescdpfion <br /> <br />New Single Family Dwelling w/garage <br />New Single Family Dwelling w/o garage <br /> <br />Garage, attached <br />Garage, detached <br /> <br />Tress( ) or P, at~( > I so. sto~ ~ IDetach~tGaragelleight: <br /> <br />2. Location of Installation <br /> <br />Su~ivbloa I ~ Bilk <br />Mo~le Ho~ P~k ~ S~ ~ <br />Se~ion /~ Towaslfip ~ ~ ~ag~ / ~ Z~* Map Wat~va~W, llSU~ly: ~ S~ing <br />Lot Wid~ L~ De~h Am~ ~eg. ~[ .... C~r Co~u~ty W*II ( ) City <br /> <br />3. Contractor Infornmtion <br /> <br />Property Owner [ Mailing Address ] Phone No, <br /> <br />( ) I own, reside in, or will reside ia the completed ,truetme. <br /> <br />( ) I will b¢ my own general contractor. <br /> <br />Architect name: [ Maihng Address: .l Phone: <br /> <br />4. Fee Schedule <br /> <br />A. New One.and. Two Family Dwelling Code <br /> (itlcude~ El. Me, PI) <br /> <br />V~uafioa: &__ <br /> <br />(1) Gra~s Sq. Ft. x $.28 <br /> <br />(2) 5% State Surcharge 605 xAI) <br /> <br />(3) Plan Review <br /> <br />(4) Zomng Surcharge ($15 if applicable) <br /> <br />= $185,00 <br />= 1~'. ~)~° .... <br /> <br />B. Msscellaneozs Fees <br />(1) Drivewayw/curb @ $7.50 <br />(2) Ddveway w/o cuzb @ $17.00 = __ <br />(3) Additional Plan Reviews or Addendurns = __ <br />(4) Investigation Fee ~ __ <br />(5) Rein~pecfion Fee @ $25.00 -- __ <br />(6) Other ImeI~ctions not Ust~d above -- __ <br />RECEIPT: ____x $40 ~ <br /> TOTAL $ <br /> <br />reverse side of'this form. <br /> <br />N anle of Applicant (Ple~e Print): <br /> <br /> <br />