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['"~OR OFFICE USE ONLY <br /> <br /> Received By: __ <br /> Zoni~lg Validlation: <br /> Date: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem, OR 97301 <br /> 8:00am-4:~0pm Phoa~ 588-5147 <br /> Col~-A-l~on* 585-7904 <br /> FAX 588-7945 <br /> <br />ONE & TWO FAMILY DWELLIIqG PERM1TAPPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. Job Description <br /> <br />(vSNew Single Family Dwelling w/garage ( ) Garage, attached <br />( ) New Single Family Dwelling w/o garage ( ) Garage, detached <br /> <br />Tress( ) or Rafter( ) <br /> <br />2. Location of Installation <br /> <br />3. Contractor Information <br /> Owm~r ' r [ Mailing Address I Phot~e No. <br />Property <br /> <br />( ) I own. reside in,,~ will res!de ia the Completed s~-uctur~. <br /> <br />( ) I uader.l, tand that I mast register az a comtructlon ~on~ractor ~f th9 structure is sold or offered for sale before m upon completion. <br />( ) I will be my own general contractor, <br /> <br />If I hiro subc, on~actors, I will hire only subcontraetor~ tegistexed with the Collst~l~tion C0~tr~'tom Board, If I ehalage my mind and do hire a g~neral contract{x <br />who i~ registered with the Construction Cont~actor's Board. I willimn~diat~:ly notify Marion County of th~ name of th~ coatracor: <br />Contractor Busine~ss name & #:..~ [ Mnillng!Addr~s: - ] Phone: <br /> ( ) I am a rngist~red builder OR th~ authorized rel~esen~at/ve of a r~gi~t~rcxl build,r, <br /> <br />Al~cltitoetnarne: ; ' ]Mailing'Addres/: I Phone: <br /> <br />4, Fee Schedule <br />A, New Om-and."l~vo Family Dw~lllng Cod~ ~: <br /> (inlcud~ ~1, Me, Ft) <br /> <br />(I) Gross Sq. Ft..~_~g~x $.28 <br />(2) 5% State Surcharge (-05 x Al) <br /> <br />(3) Plan Roview <br /> <br />(4) Zoning Surcharge ($15 if applieabhi) <br /> <br />Valuation: $. · <br /> <br />-' B. Miscellanec~ts Fees <br /> (i) Odv,way w/curb @ $7,50 <br /> {2) Driveway w/o c'urb @ $17.00 <br /> <br /> (3) Additional Plan Reviews or Addendumz <br /> (4) Investigatioa Fee <br /> <br /> (5) P.~insp~¢tion F~ @ $25.00 <br /> (6) Other InSl:eCtions not listot abow <br /> RECIglYf :_ <br /> <br />x $40 = __ <br /> <br /> <br />