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IFOR OFFICE USE ONLYI <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Slxe~t NE <br /> Salem, OR 97301 <br /> g:~am-4:30pm Fno~e 5ss-5147 <br /> Code-A-Phon~ 5~$-7904 <br /> FAX 588-7948 <br /> <br />FOR OICFICE USE ONLY <br /> k <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT .,A~; ,LIOAT, I_OJ~ <br />COMPLE~ SECTIONS, 1 THROUGH 4 ~ <br />1. Job ~crip~on <br /> <br />New Single Family Dwelling w/garage ( ~ Garage, attached MARION OOIJNTY <br />New Single Family Dwelling w/o garage ( ) Garage, d~tached BUILDING INSPEC'[ION <br /> <br />2. LocationofInstallatlon , .4/~,w~£#/l/q g/re. <br /> <br />,, ~umZuz/~, , si ao. <br />Su~ivislon ' Bilk ~ <br />MoNI~ Home P~k S~ ~ <br /> <br /> · ' ' '' ~vateW~ll ( ) Spring ( ) <br />L~Widm ~0 L~m~h /~ A~es ~,~t fro C~n~r [/~ Commu~tyWell( ) City (~' <br /> <br />(~ I am a reg~temd builder OR ~¢ ~ffx~ri~ re~esenmave of a resist*red b~ld~, <br /> <br />4. Fee Schedule <br />~. ~;~ One-aad-~wo Family Vwalin~ <br /> (inleudes I~1, Me~ PI) <br /> <br />(i) Gr~s Sq, Ft. I.~- X <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) Pl~ Review <br /> <br />(4) ~nlng Surch~go ($15 if applicable) <br /> <br />Valuation: $~,,a!~ <br /> *. ,.{185 00 <br /> <br />B. l~scellaneous Fees' <br /> (1) Driveway w/curb @ $7,5,0 <br /> <br /> (2) Driveway w/o curb @ $17,00 <br /> <br /> (3) Additional Plan Roview~ or A(Idendums <br /> <br /> (4) Investigation F~e <br /> <br /> (5) Reinsp~¢tion Fee ~ $25~00 <br /> <br /> (6) Other Insp¢ctions nol listed above <br /> <br />__ x$40-- ---- <br /> $,8¢6. <br /> 2~ <br /> <br />I hereby cerlif} that the above information Js correct and that I have read and understand the Inf~mation Nol/ce to l:'rel~tty Owners aborn Construction Re~ponsibilifie.q on the <br />reverse side of this fc~m. <br /> <br /> <br />