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FOR OFFI~2~.IJSE O~NLY <br /> <br />Zoning Vafidatioi¥ ~ <br />Date: / '~ q' q5 <br /> <br />COMPLETE ALL SECTIONS, 1 TIiROUGII 4 <br />1. Job Description <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> <br /> / 220 Higl3_ Dreet NE <br /> //~/ Salem, OR 97301 <br /> g:00a/n.4:30pm ~on~ 588-5147 <br /> Co&-A.l~hone $88-7904 <br /> FAX ~g$-7945 ~ <br />ONE & TWO FAMILY DWIgLLING PERMIT APPLICAi~I~J4 <br /> <br />('~fNew Single Family Dwelling w/gatag~ <br />( ) New Single Family Dwelling w/o gm'age <br /> <br />( ~Garage, attached <br />( ) Garage, detacla~ <br /> <br />Square Feet; Bucmcnt: <br /> <br />Tmu(k4/' or Rafter( ) ...... [ No. Storlu ~ [Deta~h~Ga~ageHeight: <br /> <br />FOR OFFICE USE ONLY <br /> <br />City Sabeek Requirements: <br />l%at: ~,,~ ' P-~: ~ '" <br /> <br />2. Location of Installation ,,/l/./4L .J~t. bt~,~8 0 ~/to~ dr~'' <br /> <br />3, Contractor ~formation .. <br /> <br />) I own, reside in, or will reside in the completed structure, <br /> <br />) I ~ndtrstand that I mu.~t regi~er ~q a con~tmcfion contractor if the smlcture is S01d or:0ff~d f~ sale I~dore ~ upon completion. <br /> <br />) I will be my own general eontsactor. <br /> <br />If I hire subcontractors, I will hire only subcontractors registered with the Cons~Tuction Contractors Board, IfI change my mind and do hire a general eOntracto~ <br />who is registered with thc Constructio. Corm-actor's Board, i wi~iJn~i~tely notify Marion County of the name of the contracor: d~t./~J. ~'l.g t ~L-'L~ .;.~0 d <br /> <br />~dtitectname: ~ ~ ~,~ .... ".lM~l[n~AO~¢ss: ,],Pho.*: <br /> <br />4. Fee Schedule <br />A, New One-and-Two Fatally Dwelling Code <br /> (inlcudea El, M~, PI) <br /> <br />Valu.tion: <br /> <br /> (2) 5% State Surcharge (.05 x Al) <br /> (3) Plal~ Re~iew <br /> <br />· ~llia~.~ q u re hars,'( ¢I] ~G f4~,p pLi~,al~l e ) <br /> <br />: 41, <br /> <br />B. Miscellaae~s <br />(1) Driveway w/e~mb @ $7.50 <br />(2) Driveway w/o curb @ $17.~ = .... <br />(3) Ad~fioaal ~ ~vi~ws or ~d~du~ = <br />(4) Investigation Fee = <br />(5) Reins~cfion P~ ~ $25.~ = <br />(6) ~ Insertions ~t listed ~ve <br /> /7¢ ............ <br /> <br /> I hereby certify fhat Ihe ahove ird'ormafion is correct and that I have read and understand the Id~mafion Nc~ce o Propoily Owners about Construction Responsibilities on <br /> <br /> Site evaluaOons, sephc, e~ncal, plumbing and mac'cai work r~ffire s*~r~t~ ~r~. Check wi~ M~bn County B~]ding Iron.ion ~fore ~uhmilting Otis application <br />MC 15-80 Rev. 1~2 <br /> <br /> <br />