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om¢ use ONLY <br />Izo' g <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, OR 97301 <br /> 8:OOaro-4:3Opm Phone 588-5147 <br /> Code. A. Phone 558-7904 <br /> FAX 58g-7945 <br /> <br />J City Setback Requirements: <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATIO~ <br />COMPLETE ALLSECTIONS. 1THROUGH4 ~ ~ ~ <br />L job Description <br /> <br />(t4'~e~v Single Family Dwelling w/garag& <br />( ) New Single Family Dwelling w/o garage <br /> <br />(t.-'y~-~rage, almched <br />( ) Garage, detached <br /> <br /> M^I ION GOtJNTY <br />BUII. DIN i I $P[gTION <br /> <br />Squareh'ael: Ba-~ement: lOqp [M.i. noor: 1'-4-1 ~) Ise~°"an°°r: <br /> <br />2. Location of Installation ' ~ ~c.. [r~tZawq (~_. ~7D , ~ <br /> Private Well ( ) S~ing <br />LmWid~/~,2~ La~lTf,bg Acres ~eg.~t Comer CommMtyWdl( ) City <br /> <br />3. Contractor lnfomnation <br /> <br /> I under~tand ~at I mmqt register mq a constm~on con~a~ if ~e s~a~o ia sold Or offerod f~ sale ~fore or u~n cmplefion, <br /> ~l will ~ my own general contra~. <br /> <br />If I hit* subcontractors, i will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor <br />wile is registered wifll the Conswuction Corm-actor s Board, I will immediately notify Marion County of fle na e of d e co tracer <br />Conlraetor B slness name & # [ Mailing Address: { Phone: <br /> <br />( ) I am a registered builder OR the authofizod relxesentative of a registered builder, <br /> <br />Arehit~fitaime: :' '": : ' '" ]MaillngAddre~e <br /> <br />~. Fee Schedule <br /> <br />A, New One-and-Two Fanfily Dwelling Code <br /> (uilcodes El, M*, I'l) <br /> <br />B, Miscellaneous Fees <br /> (I) Driveway w/curb @ $7.50 <br /> <br /> ~) Driveway w/o curb (~ $17.00 <br /> <br /> (3) Additional Plan Reviews or Addenduras <br /> <br /> (4) Investigation Fee <br /> <br /> O) Reinsl~Cti°n F~ @ $25.00 <br /> (6) Other Inspet~,ons not lls~ed above <br /> <br />TOTAL <br /> <br /> I hereby certify ~xat the alx)vc information is correct and lhat I have read and Understand thc Information Ncaiee to Property Owners about Construction Rcaponsibiltiiea on thc <br /> reverse aide oHhis form. <br /> <br />MC l~-aO ~v. 1~ <br /> <br /> <br />