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MARION COUNTY BUILDING INSPECTION <br /> 220 High. Street NE <br /> Salom, OR 97301 <br /> 8:00am-4130pm Hmne 588-5147 <br /> Code-A-Phoe,* $gg-7904 <br /> FAX 588-7948 <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 TItROUGI-I 4 <br />1. Job Description <br /> <br /> / <br />( KNew Single Fmnily Dwelling w/garag~ <br />( ) New Single Family Dwelling w/o garage <br /> <br />( ~Garage, attached <br />( ) Garage, deu'~bed <br /> <br /> / <br />':Ih,ss (~f or Rafter ( ) I ~o. s~o:,/ Il~tached G~rag~ H~i~ht: NO. Be. droon~: ,.~ <br /> <br />2. Location of Installation <br /> <br />I Mo~le Home P~k S~ee g <br /> ....... ~ivateWell ( ) Spm~g ( ) <br />:L~Width ~,&7 ~De~h ~D~ A~ez Igeg,~t ~ Comer ff~ CommunltyWell( ) City (~ <br /> <br />( ) I own, reside in, or will reside Ju the completed s~ct~e. <br /> <br />If I hire subcontractors, I will hira only subcontractors registered with the Collsnxlction Contr~torZ Board. If I change my mind and do hire a general eonlractoe <br />who i$ registered wJfll the Construction Contractor's Board, I will immedlat~l? notify Maxion County of the laame of the collnaour: <br /> ~ . . ~ ,'~ re'~ q ~]JoOb~ <br /> <br />~). I am a registered builder OR the authorized representative of~ registered builder, <br /> <br />4. Fee Schedale <br /> <br />A. New One-a~d-IN~o Family DWelling <br /> (inlcud~s El, Me, <br /> <br />Miscellaneous Fees <br />(1) Driveway w/curb @ $7.50 <br />(2) Driveway w/o curb @ $17.00 <br />(3) Additional Plan Review~ or Addemiutm = __ <br />(4) Investlgation Fee -- __ ...... <br />(5) Reinspeetion Fee @ $25,00 <br />(6) Other Inspections not listed above <br /> <br />I hereby Certify that the above infofl/lafion is correct ~nd lhat [ have reed and und~stand the Information Notice to Property Owners about ConstnletJon Rospons ) Iii/es on the <br />reverse side of this fortn. <br /> <br /> <br />