Laserfiche WebLink
FOR OFFIC.~ USE ONLY MARION COUNTY BUILDING INSPECTION FOR OFFICE uSE ONLY <br /> "... 220 High Stxeet NE <br /> · . ~ ~ S~, OR 97301 ...... , <br />]ZoningV~fion: F~ s:~m-4a~m~S*~i47 a}}t~./~ ~ ~o~: ~O [ ~:,,~-~ <br /> <br /> comPLe~ ~L Sr~Z~O~S, ~ ~mOUG~ 4 <br /> <br />No, Stories <br /> <br />Location <br /> <br />,,~a~xd~lle, ~r~ qyZ~, " slt~o, <br />Mobile gome P~k S~e g <br />' Commu~ty Well ( ) City <br /> <br />3. Contractor Information <br /> <br />] Mailit~g Addrc~ I rhone Nc,. <br /> <br />) I own, resld* in, ov will coside in the completed structure. <br /> <br />) I understand that I must register a.s a core, tractiOn contractor if th* strutlt~e is s01d or offered for sale before or upon compl¢,tioa. <br /> <br />) I will b~ my own general contractoc. <br /> <br />4. Fee Schedule <br />A. New One-and-Two Family Dwellilag Code <br /> <br />(2) 5% State Surcharge (,05 x Al) <br /> <br />(3) Plan g~via, w <br /> <br />(4) ~ning Surch~e ($I5 if a~li¢~lo) <br /> <br />~¢.~./% <br /> 85,00 <br /> <br /> x$40= <br />TOT,~ s.Big, <br /> <br /> I hereby certify that thc above information is correct mad that I have read a~d understand the Infoemafion No6¢~ to Property Owners about Construction Responsibilities on the <br /> reverse side of this <br /> <br /> S <br /> J e ¢valua xons, sepuc, e e~ncal, plumbing ~d mecl~nical work ~qMr* $o~rate ~, Check wifll M~iou County BMlding Imp~ion bforc subnfitfing {his ~plication. <br />MC 15-80 Rev, 1D2 <br /> <br /> <br />