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FOR OFFICJE USE ONLY MARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY <br />Received By: ~ (5 220 High Sa'st NE city $~tlxack Req~emen~s: <br /> t S~em, OR 97301 ~: ~ ~ <br /> <br /> O~ & TWO F~Y D~LL~G PERM~APPLI ~ <br /> <br />1. Job Description ~ ~ ~ <br /> ( ~New Single Family Dwelling w/g~age (~¢, at.bed ~alO~ OOUN~ <br /> ( ) New Single F~ily Dwelling w/o g~e ( ) Gm~e, &~bed BUILDING INSPEO] :,] , <br /> <br />Tru~s ( I~ or Rarer ( <br /> <br />INc. Stories ~ I Detached Garage Height: No. Bedroonls: ,~ <br /> <br />2. Location of Installation <br /> <br />Job Address ~ ~ q t~ t Tax A¢¢t No Cross Street <br /> <br />Sec, ion ~ Town~p ~ 5 Range ~ ~ ~no ~ Map . ..~ Wagr <br /> PfivamW~ll ( ) Spring <br /> <br /> Contractor Information <br />Pro~ay Ownerd$~,LL_ ~ <br /> <br />Mailing Addro$ <br /> <br />No. <br /> <br /> ( ) I own, reside in, or will ~e~ide in tho comphtt~i structure.. :: '; <br /> <br /> ( ) I understand that I mt~t register a~ a eomlructioa contractor if the ,tnaatr~e 1, *old or °ffemd for sale before or upon completion. <br /> ( ) I will be my own general contractor. <br /> <br />If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mlnd and do hire a general contractor <br />who is r,gJstered with the Construction Contractor's B cmrd, I will immediately notify Marion County of the name of the eon:racer: <br /> , '2q~ .................. <br /> <br /> ~I am a r¢gister*d builder OR the authorized representative of a registered builder. <br /> <br /> Al~ehitect <br /> name: <br /> <br />4. Fee Schedule <br /> <br />A. New One-an&Tw0 l~amily Dwelling Code <br /> (inlcud~ El. M~, PI) <br /> <br />(1) OrossSq. Fl. /'74~ x$.28 <br /> <br />(2) 5% State Surcharge ( 05 x Al) <br /> <br />(3) Plan Review <br /> <br />(4) Zx, niag S rchargo ($15 if applicable) <br /> <br />Yahi,rio.': * <br /> <br /> x <br /> <br />TOTALS <br /> <br /> SJl¢ *wthxafions, sepfi~ectrical, plumbing ~d mccha~al w~k req~r* serrate ~kq. Check wi~ M~ion County B~Iding l~ction bfo~ ~ubmitmig this ~plicafion. <br />MC 1540 Rev. <br /> <br /> <br />