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liF61~ CITY VALmATIONI <br /> <br /> oniag Validation: ~, .$ <br /> ate: ~O/~,[q(~ I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 9730l <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 hr. lnsp~clion Line 373-4427 <br /> FAX 588-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />Lefi Side:.~ Right Side: ~ <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />( ) New Single Family Dwelling With Attached Garage <br />( ~Ncw Single Family/)welling With Detached Garage <br />( ) New Duplex <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />[ Second Floor: ~ 0 [ Garage: <br /> <br />No. Bedrooms: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on sq~ footage: <br /> <br /> Electrical (~ .068 per sq fi <br /> <br />$ <br />$ <br />$ <br /> <br />$ yo. oo <br /> <br />s . 57,ob <br /> <br />Bo PERMIT FEES <br />3, P~ Review F~ (A-2) = $ ~ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the Jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for lnstru, ctions. <br />I hereby certify that the above information is cortcct./Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days, <br /> <br />Sigllatur~ofApplieant: ~.,~p.,.) ~~ Date: <br />MC 15-80 Rev 1/96 <br /> <br /> <br />