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Zonin.g, Valicl~i~n: w~'[ ,- <br />Da :' A- lq <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem. OR 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FAX 588-7948 <br /> <br />[~O_R.~O_~FICE USE ONL~Y <br /> City Setback Requirements: .......... <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT A]P~. vC4~I~N~ ~ <br />COMPI,ETI". ALL SECTIONS, 1TI'IROUGH 4 ~1~ ~*~ U [~ I ~ ~ <br />1. Job Description <br /> <br />New Single Fmnily Dwelling w/garag~ <br />New Single Family Dwelling w/o garage <br /> <br />(]~q. Garage, attached <br />( ) Garage, detached <br /> <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />2. I,ocatlon of Installathm <br /> <br /> Job Addtr~s~ '[ ~ ' ~ . Cr os,q Street <br /> i ' II ill I ~b~~] ~ Ti* *¢¢'' Noqo~ 2 ...... <br /> <br />t .o.,.p Io6 <br /> ~ PrivaleW~ll ( ) Spring ( ) <br />LotWidth ~./ L~De~h [~fi Acres ~eg,~t ............ Corner ~ Community Well ( ) Ci~[,,~___ <br /> <br />3. Cuntractor infornmtion <br />Property Owu'~ }x Mmhng Address~k[ ~o ~ ~~ <br /> ~ I own, re~ll reside in ~he completed ~tm~e. <br /> <br />~f~hir~s~hcont~act~rs~wi~hireon~y~ub~n~ract~rsregisteredwiththe~n~ruc~i~nC~ntract~r~B~ard If I change my nfind and do ]fire a general ¢ootraclor <br /> <br />Contractor Bu.qin¢~s name & #: [ M~iling ^ddres$: ] Phone: .......................... <br /> ( ) I am a registered builder OR the authorized re~esentative of a registered ~ild~. <br /> <br />~chitect naine: I Mailing Address: I Phone: <br />4. yee Schedule <br /> <br />A. lqew One-and-Two Family Dwelling Code <br /> (inlcud~.q Iff, Me, PI) <br /> <br />(1) Gross Sq. <br /> <br />(2 Stat, <br /> <br />(3) Plan Review <br /> <br />B, Miscdlf*neous Fees <br /> <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o curb @ $17,G0 <br /> <br /> (3) Additional Plan Reviews or Add*ndums <br /> (4) Investigation Fee <br /> <br /> (5) Reinspecfion Fee @ $25,00 <br /> <br /> (6) Other Inspections not listed above <br />r~sc:~:~rr: ('Xozdr-~a~ I <br /> <br />.............. x$40= .... <br /> TOTAl, $ .~.~.-~> ~ <br /> <br /> I hereby ccrti£ OuR the above information is correct and that I have read and understand the Infcxmalion Nc~ice to Property Owners about Conslractlon Reaponsibililies on the <br /> reverse si¢le Cfflhls form. , <br /> <br /> Site evaluations, septic, electrical, plu m~=~lx:~r¢"~rm~$;-Ch~,k with Mmon County Building In,p,orlon before subm~ging ~h~s appl~¢almn. <br />MC 15-80 Rev, 13)2 <br /> <br /> <br />