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1 o} o?mj OmLY <br /> <br /> COMPLE~ AI.L SECTIONS, 1 ~ROUGH 4 <br /> Job De~ription <br /> <br /> MARiON COUNTY BUILDING/NSPECTION <br /> 220 Higl! Street NE <br /> Salem, OR 97301 <br /> $:00am.4;30pm Phone 588-5147 <br /> Code-A-Phoa* 588-7904 <br /> FAX 585-7948 <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />( l~New Single Family Dwelling w/garage <br />( ) New Single Family Dwelling w/o garage <br /> <br />( ~arage, aUached <br />( ) Garage, de[ached <br /> <br />Tmsa(I/y' or Rdter( ) I Ne. Stories / {DetaehedOarageHeight: <br /> <br />2. Locationoflnstallafion J] /) mJ' U.' L ~. t~ <br /> Phone No. <br /> <br />· . ~/~. . ~-~ Tax Acct. No. . ....... <br />Mobile Home Pi~k 8~ce ~ <br /> <br />~Widd, /~O / L~De~h~ Acted ~eg.l~t ~:y Comer ~ CommunityWall( ) City <br /> <br />3. Cnntractor Information <br /> <br /> ( ) Iown,~sid~in,~willresid~intheeompl~t~e. <br /> <br /> ( ) ~&~mnd~n~t~m~qtregi~erasa~m~tmu~m~t~if~s~m~ei~s~d~r~df~rsa~e~f~re~ru~n~mp~n. <br /> ( ~will ~ my own general comraaor. <br /> <br />( ) I am a registered builder OR the authorized representative of a r¢gistered builder. <br /> <br />4. Fee Schedule <br />A, New On~-and-Two Family Dwelling C~e <br /> <br />(l) oro~ Sq, Ft..~ ~ ~ SaS <br />(2) 5% State Surcharge (.0.{ x Al) <br /> <br />(3) Pltm geviow <br /> <br /> B. Miscellauec0as Fees <br /> (I) ~veway w/crab O $7.~0 <br /> ~) ~veway wlo a~b ~ $17.~ <br /> (3) Additional Plan Re'ewe ~ Add~ndums <br /> (4) Inv~qtlgafion Fe~ <br />= ~1,~.~ (5) ~eins~eliou F~ ~ $25,~ = <br /> / ~ 7, / 7 (6) ~er Ins~eOona not bated ~ove = __ <br /> <br />hereby c¢fiJl~ that the above information is Coffee! and that I have read and ulldorstand the Infer hidden Notice to [~y Owners a~t Coua~ucfion Re~nsthilifies on the <br /> <br /> 8ite e~aluationl, lephc, ~l~arlcal, plumbing and m~chlmcM work mqda se~rat~ ~nIi~, Cheek wMl Maio~ ~oumy gmlding lni~ion kfom iubmtthlg ~il ~pfi~aion, <br /> <br /> <br />