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MARION COUNTY BUILDING INSPECTION <br /> Salem, OR 97301 <br /> 8 ~am-4:3Opm Phone; 558-5147 <br /> Cod¢-A-Pho~ 588-79~ <br /> F~ 588-~48 <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLI~.4~T4~N <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 ' ]~);]g(~~'~ <br />1. Job~scrip~on ~ ~ C~t~t~ <br /> ( ~ew Single vamily Dwemng w/g~ge ( ~ge, at~hed DEC { ~ 199 <br /> <br /> (1) New Single Family Dwelling w/o g~tage ( ) Garage, detached <br /> <br /> / <br />"i¥,~s(t.( or Ra~rS....? I~o. Slori~s ? [..D~h~Oaragemi~t: <br /> <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />I Other: <br /> <br />2. Locationorlnstanafion JLa. ~-,~,dr~ q7~3 <br /> <br />3. Contractor Information <br />l'roperty Owner ~q.~g.~ ~::Z~ <br /> <br />Mailing Address. [ Phone No, <br /> <br />own, r~ida itt, er will reside in the completed structure. <br /> <br />uederstaod that l must register a~ a ¢on~tmctlo~ contractor ff the stmam'e is sold or offered for sale before m- upon compi*~Jou. <br />will Im my own general contractor. <br /> <br />If I hire subcontractors, [ will ix/re only subcontrat;lor$ registered with the Construclion Contractors Beard. If I challgo my mind and do bJre a general contractor <br /> <br />who i~ registered with tile Construction Contractor's Board, I will imm¢diatalv nog>' Marion County of the nam* of the ¢ontraeor: <br /> <br />Contra¢lor Btmness name & g: b'~ I/~ ~ f/~ t ~'~ -~ Mailing Address: ~ Phone: <br /> <br />........ !)Q I am a registered builder OR the3 authorized representative of a registered builder. <br /> <br /> ])e ttq ~e r~ 73[vdl, <br />4. FeeSchedule ~ ,, . ~'PorT~lo,d /)r.e~ <br /> <br />A. New One.and. Two Family Dw*llthg Code <br /> (inlcudes El, Mo, PI) <br /> <br /> (I) (;ro~s &,. Ft. ~/-ff. d~_~_ x $.28 <br /> (2) 5% Slate Surch~e (.05 x Al) <br /> <br /> (3) ~ Review <br /> <br />B. Misedlaneems Fee~ <br /> (1) Driveway w/~b @ $~'~0 <br /> (2) ~iwway w/o emb ~ $17.~ <br /> <br /> (3) A~ifional ~n Renews ~Add~ndu~ <br /> <br /> (4) Invasfigafi~ Fcc <br /> <br /> (5) ~ns~cfion F~ ~ $25.~ <br /> (6) ~er In~fiom~ n~ lls~d ~vo <br /> <br />I hereby ce~jfy that tile above information is conteet and that I have read and understand the Infernal on Notice to Prcl~erty Owners abo~t Construction Respon~Jbdifies on <br />reverse side of this form. ' <br /> <br /> <br />