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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem~ Oregon 97301 <br /> g:00am-4:3Opm Phone $88-$147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />Le/tSide: ~"/ m~t$1de: f / <br /> <br /> ONE & ~NO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br />New Single Family Dwelling With Attached Garage <br /> <br />( ) New Single Family Dweging With De~ached Garage <br /> <br />( ) New Duplex <br /> <br />Energy Path: ~Vg-~ No. Stories J { Detached Garage Height: <br /> //3/ <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE 1NDICATE WHO IS DOING THE WORK <br /> () <br /> <br />Block ~ <br />Wa~ Supply: <br />Private Well ( ) Spring <br />Community Well ( ) City <br /> <br />4. FEE SCF/EDULE <br /> <br />VALUATION - Based on aquar~ footage: <br /> Gross gq Fttfl~x~ 64.66 <br /> Oarag~ Sq x 16.27 <br /> <br /> Gross ~l Ft ~7~ x $.3ns/sq <br /> <br />$ <br /> <br />$ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed ~l the ]obsite prior to inspection for pinmbing, electrical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby certify tha the ~bove information is correct. P~rmit~ ar~ non-transferrable ~d expire if work is not s~r ted within 180 days of issuance or if work is <br />180 days. <br />Name of Applicant (Please Print):~/~/'~t ~Z~/'~, ~gf~- ~ Phone: /~3~c.~ <br /> <br />MC 15-80 R~v 1/96 <br /> <br /> <br />