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voR ovnc use ONLy <br />I Re°'ive <br />Zoning Vali,d~.,tion: '~' Front: <br /> <br /> O~ & TWO FAM~Y D~LL~G PE~ APPLIC~ ~ <br /> 1. job ~ription _ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Sn'eet NE <br />galean, OR 97301 <br /> <br />FOR OFFICE USE ONLY <br /> <br />Right <br /> <br />( bO/New Single Family Dwelling w/garage <br />( ) New Single Family Dwelling w/o garage <br /> <br />(~/Garag¢, attached <br />( ) Garage, detached <br /> <br />~l.~-~J) or Ratter ( ) INo. Stories / IDetached Garage Height: <br />Square Feet: Ba-~ement: [ Main lqoor;fl/_5".~ ] Segond Hoer; <br /> <br />Garage: <br /> <br />No. Bedromm: ~ <br /> <br />2. Location oflnstallatlon ~.q~/ 7~'QJ <br /> <br />Sul~ivJ~iou L~ // Bl~k ~ __ <br />Mobile Ilome P~k SDace II <br />S=caion ~ Towq~?~ ~5 Rang* ~ Zoa~ ~gt, Map Wa,~Su~Iy: <br /> ' PdvamWell ( ) Spring ( ) <br />I,oW, ch ~t L~De~l,/~q~ Acres l=eg,~t ~S Corner ~ Com,nu~tyWell( ) City <br /> <br />Contractor Information ., a <br /> <br /> ) [ own~ reside in, or will reside in the eonlpletod struct~e, <br /> <br /> ) I will be my own general contractor, <br /> <br /> ~ I am a registered builder OR fl~u~ori~d re~esentafiv~ of ~stered bmlder. <br />Arch}get name: , M~liag Address: Phone' <br /> <br />4. Fee Schedule <br /> <br />A, New One-and-Two Family Dwelling Code <br /> (inleudes El, Me, FI) <br /> <br /> 28 <br /> <br />(2) 5% State Surcharge (.05 X Al) <br /> <br />(4) 7~Nng Surcharge ($15 if applic~l~) <br /> <br />Valuation: $~ <br /> <br /> -- $185.00 <br /> <br />B. Miscellaneous Fees <br /> (1) Driveway w/curb I~ $7,50 <br /> <br /> (2) Driveway w/ocurb ~ $17.00 <br /> <br /> (3) Additional Plan Reviews orAddeadums <br /> <br /> (4) Investigation Fee <br /> <br /> ($) Reinspc¢-tion Fee @ $25.00 <br /> <br /> (6) Other Ins!ecetions not.listed above <br />RECEIPT :__~___~_'~y <br /> <br />............ x$40= __ <br /> <br />Nam¢ofAppl{¢ant~int) , ,L, Fbone:3%O-ygXq <br /> <br /> <br />