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[y.R CSTY VALIDA.T~pN <br /> R~eived By: ~ <br />Zoning Validation: ~ <br />Date: ~'~--~-- ~'~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 58~-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />FOR CITY USE ONLY <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />*Includes electn'cal, mechanica~ plumblng fees <br /> <br />(~ew Single Family Dwelling With ARached Garage <br />( ) New Single Family Dwelling With Detached Garage <br />( ) New Duplex <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />~t Wid~ Z~ j~ ~t~ <br /> <br />!OCT <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> () <br /> <br />() <br /> <br />I ~m an AUTHO~ I?~l~r~ R~RESENTATIVE of flae properly owner or con~'actor. <br /> <br /> (plea$~ pfipt) <br />Mailing Address Phone <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Ba~d on square foo~_e: <br /> Gross Sq Ft ~ x 64.66 <br /> Oarag~ Sq ft <br /> TOTALS: <br /> <br />B. PERMIT FEES <br /> <br />2. State St, rchar~e ($0/0 of A. 1 ) :$ .~t~, ag~/ <br />3. Plan Review Fee (A-2) /g~o ~' =$ ~/~'~& <br /> <br />6. Reinspeeti~ Fee $25.~ = $ <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 instructions. <br /> <br />I hereby certify that the above information is correct. Permit Lc and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days, <br /> <br />Phone: <br /> <br /> <br />