|
FOR OFFICE USE ONLY]
<br />Zo!fing Va~id,afion: ,~ ~ ~, ~
<br />
<br />COMPLETE ALL S~TIONS, 1 THROUGH
<br />
<br />1. Job D~scripfion
<br />
<br /> MARION COUNTY BUILDING INSPECTION
<br /> 220 Higl] Street NE
<br /> Salem, OR 97301
<br /> 8:00am-4;30pm Phone 588-5147
<br /> Code-A-Phone 5gg.7904
<br /> FAX 588-7948
<br />
<br />ONE & TWO FAMILy DWELLING PERMIT APPLICATION
<br />
<br />( ~New Single Family Dwelling w/garage
<br />( ) New Single Family Dwelling w/o garage
<br />
<br />(~Garage, at~ached
<br />( ) Garage, detached
<br />
<br />[Left Side'. ~ g ~ght gide:
<br />
<br /> MfiRiON O, OUNI'Y
<br />BUILDING INgPt~CTION
<br />
<br />Tress (,,/~' or Rafter ( ) j No. Stories / ] get~ch~l a~-ag,~ Height: No, BecJroo,ms: .~
<br />
<br />Location oflnstallatlon ,A4..~. ~ ~/e~ ~ 7~¢/
<br />
<br />Jo~,A~re,s ¢~d ....'De/nC,orZ~J .... T,,¢,~,,.~o.¢~0/.~..~¢~! Cro~,str,~,
<br />s.x~.~,~o. ~/~,ru, I/~ ~/~: .... ~ ~/ ~'~ ~ ,
<br />Mobile Home P~k $~ ~
<br />Se~io,, ~fl- I Town~hlp ~ g~g* ~ ~ ~ne ~ ~ Map Ware; Su~ly:
<br /> ...... Priva~Well ( ) Spring
<br />
<br />3, Contractor information
<br />
<br /> ) I own, reMde in, ~ will rezide in the completed
<br />
<br /> ) ~und~mtandthat~m~t~egiste~a~ac~nstm~n~n~a~t~s~e~s*~]d~r~r~f~r~a~f~e~ru~n~mp~n-
<br />
<br /> ) I wHI be my own general comrade,
<br />
<br />.....who is register~l with the (. onstruetion Contractor's Bo~d, I w 1[~[~ ~' i ¢ y nodfy Marion Corm ,Y of the name of the contra¢or-,
<br />Contractor Bu,'ness na~ ~e & # ' f .... Mailing Address ./,~ Z~ Phone ~ '
<br /> ("~fi ~m a registered b.ilde~ OR ~h~ ;;thoriz~d ~e~¢ntative of · ~istereO bmld~[ .....
<br />
<br />4. Fee Schedule
<br />A. New One-anti-glare Fandly Dwelliag Code
<br /> (ial~d~q El, Me, PI)
<br />
<br />(1) Gross gib Ft, J~-~ x $,28
<br />
<br />(2) 5% State Surcharge
<br />
<br />(3) Plan Review
<br />
<br />~/' ~ (3) Additional Hah Reviews or Add~dums ~ ~
<br />= ~./d (4) Inv*sfigafim Fee = _ ......
<br />= ~.5,~ (5) Reins~cfioa F~ ~ $25,~ = ~ .......
<br />
<br />_,~__x $40 =
<br />
<br />MC 15-80 Rev, 1/92
<br />
<br />
<br />
|