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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Sal~an, OR 97301 <br /> g:00am-4:30pm Phone 588-5147 <br /> Code-A-Phon~ 558-7904 <br /> FAX $88-7948 <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. Job Description <br /> <br />( bCj/New Single Family Dwelling w/g~ag~ <br />( ) New Si~tgle Family Dwelling w/o garage <br /> <br />( ~arage, attached <br />( ) Garage, detached <br /> <br />2. Lo=~on oflns~lla~on ~ &~ q 7dO~ <br /> <br />Mobil~ Home P~k S~ 8 <br /> ' ' I Wa~c Su~l~: .... <br /> ~ ~vat~Well ( ) Spring ( ) <br />to,'~i~th7d.o ' V.hq7.~/ xet*s ~.~t ~ ~me, ~O Commu~tyWell( ) City (~ <br /> <br />3. Contractor lnfomatlon <br />pro .yOw% ¢-o <br /> <br />[ M~Jnng Addr~ I Phone No. <br /> <br />own, reside in, ~ will reside in the completed <br /> <br />understand that I must regi*ter a~ a constmctima contractor if the, $ttuct~r¢ b ~old or offered for sale before or upon completion. <br />wi be my owi~ g~nera] <br /> <br />4, ,,Fee Sehe,dule <br />A. New On,-and. Two Pamily Dwelling <br /> (inlcude~ El, M~, PI) <br /> <br />If I Dire subcon~,~torr, I will hlw only subcontractors regist,a'ed with tho Cowaructioa Contr~ztors Board. If I change my mind sM do bite a general ¢ori~ractor <br /> <br /> (.~.) [ am a registered builder OR ~* ~d r*~esenmdve of a roglamr~, b~/d~. <br /> <br />(I) c,~oss sq. lt./o/'C x $,28 <br /> <br />(2) 5% State $urcbarge (.05 x Al) <br /> <br />(3) Hm Review <br /> <br />(4) 7.ordltg Surcharge ($15 ffappllcable) <br /> <br />= ~,ol <br /> <br />~ $1S5.00, <br /> <br />B.' Miseellaneetls Fees <br />(1) Ddwway w/c'~b @ $7,50 -- ~,__ <br />(2) Driveway w/o emb @ $17.~ = ~ <br />(3) Ad~fioual Plan ~ews or Addeadums = ~ <br />(4) Invesfi~fim Fee = __ ....... <br />(5) R~ns~on F~ ~ $25.~ = ~ <br /> <br /> TOTAl $ ¢~, / ~ <br /> <br /> Sile evaluations, septic, electrical, plumbing and mechanical work req~re se~rata ~r~U, ~eck wi~ M~Jon County B~lding I~aion ~fore submithng ~is ~plication, <br />MC 15.80 Rev. 1~2 <br /> <br /> <br />