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r'~ .................................. n MARION COUNt{ BUILDING INSPECTION ............................................................ <br />I~R CITY USE ONLY . ~.~ I COMMUNITY DEVELOPMENT CENTER FOR CITY USE ONLY <br />] ReCe~edBy: ~, Dat¢:o~-~?~ I 3150 Lancas~r Dr. NE-SuileC City Setbacks' <br /> <br /> ONE AND TWO FAMILY DWELLING PERMIT APPUIC&~IDN ~b]l! I <br /> <br /> Dw~illag inl~la must b~ obtained at Marioa Coaaty Building Ins~¢aoa a~d m~t I~ t~ed at t~ag~t~q4~.. ~aoa for lilam~. ~l~etrleal a~l me~hamcal <br /> <br /> -~ NewSthgleFamilyDW¢illngwilhA~achedGatage ( ) New Dupinx with Attached Oarase <br /> <br />( ) New single Family Dwellthg with De-taehed Garage <br /> <br />De~riptionofWork: //~{J Co't4~(Y4A~-fo'v~ <br /> <br />( ) New Duplex with Delae.&d Garage <br /> <br /> / <br />~ellMg HeiSt: O~ Heir: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />BusinessName(pleaseprint) ~'~"t'AJff.(_~ ~y~ff~ ~ ~'/L~/MO~,EI.{L~r! <br /> <br />1 ann a CONTRACTOR registered wi~h the State of O[egon. <br />BusinessName(pleaseprmt): ,..~./'-~,/~_~$ ,A/'~:'l~ <br />MailinilAdar~s~',',~]6"] L01'I~c(~-. Or ~ <br /> <br /> Street City Zip Phone Fax <br />4. FEES <br /> <br />VALUATION (S~e Valuation Schedule to datennine the valuation ba~ed on square <br /> Garage Square Feet .t~ x $16.27 = $ <br /> <br /> Cross Nuare Feet ~-- x $0.4050 = <br /> <br /> BuildMg ~ $0.185 ~ ~uare f~ <br /> EI~I ~ $0.090 ~ ~u~e f~ <br /> M~i~ ~ $0.~0~u~f~ <br /> PlumbMg ~ $0.090 ~ ~uare ~t <br /> <br /> 2. Plan R~iew Fee <br /> <br />B. Fee Summary <br />(1) Pemlit Fee (A-I) $ <br />(2) State Surcharge (.05% x A-l) $ <br />(3) Plan Revinw F~ (A-2) $ <br />(4) ~ PI~ R~/~um ~ $50~, <br />~imum ~fhour. $ <br />(4) ~ing Surc~ if a~l~ble ($30.~) $ <br />(5) l~on F~ ($.~50 ~ ~. R.) $ <br />(6) ~ F~ $50.00 $ <br />(7) ln~in~ ~& ou~i& ofn~l <br />~s~ ~u~, $50~, ~n~um ~ ho~ $ <br />(8) Ins~i~ ~ ~i~ no ~ is s~ifi~y <br />~t~ $50.~, ~um one h~r $ <br />(10) Foun~ ~ly ~fi~, $25.~ $ <br /> ll ) ~1 S~ of~ $10.~ <br /> <br />I hereby certify that the above information is coeccct. Permits are non-transL*rrable and ~_~ if work is not started within 180 days of issuance or if work is susgended for 180 days. <br /> Name of Applicant [Pleas~ Print]: .~'~-A,/~' <br /> MailingAddress: ~3'67 Odt'/~/f.~. <br /> <br />SZgnature of Applicant: ~'~,/~ Duta: .-~-~'..~:'q ~ MC I~O 9/~ <br /> <br /> <br />