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FOR OFFIC.~. US~E 9,.NLYI MARION COUNTY BUILDING INSPECTION I FOR OFFICE USE ONLY <br /> Received By: ~- I 220 High Street NE <br /> Zoning Validation: ~I s~am, OR 97301 ICity Scth~ek Requlrem~nts: <br />lDa~ /~' 7~ -q~ ] <br /> <br /> COMPLE~ ~L S~TIONS,, THROUGH 4 ~--' ~ <br /> 1. Job Description ...... ~ .... ~ _~ <br /> <br />( ~ew Single Family Dwelling w/garag~ <br />( ) New Single Family DweUing w/o garage <br /> <br />( '~G~e, aUached <br />( ) Garage, ~tached <br /> <br />MARION COUNTY <br />BUILDINa iNSPEOTION <br /> <br />3. Contractor Information <br /> <br />I Maihng Addresz ']' Phone No. <br /> <br />I, own, reside in/ot will reside i~ the completed structu~e~ <br /> :understand that I most register as :~'~,o~tructkm eontramor:ff the stm ~ul~ is sold or offexod for sale before or upon completion. <br /> will b~ my own genoral COntractor. <br /> <br />II' I hire subcontractors, I will hlr~ only subcrontrac'tcxs regiswred with ~e ~ns~on Con~ors B~d. If I change my ~nd and do lfite a general ~otraa~ <br />who is regia~ wla ~ Cons~on Cone<~'s B~d, I will i~l~ n~y M~oa County of a~ aa~ ~ ~e uon~oor: <br /> <br /> ~lam, regist~od build: a~ ~a~n~five~er~d b~ld~, <br /> <br />4. Fee Schedule <br />A, Ne w Oae:~.d-Tw~ P~raJly Dwelling Cod~ <br /> <br /> Sq. s.zs <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) PI~ Review <br /> <br />(4) 7~nlng Surcharge ($15 ifapplic~le) <br /> <br />n,: Mise~llane~ <br /> (I) l~veway w/curb @ $7,50 <br /> <br /> (2) Driveway w/o~b ~ $17,~ <br /> <br /> (3) Additional Pl~,~view~ or~d~du~ <br /> (4) I~sfigafi~ Fee <br /> <br /> 0) Rans~caon Fe~ ~ $25,~ <br /> (6): ~er I~ not Usted ~ve <br /> <br />x $40 = __ <br /> <br /> 1 hereby F.ertif?.~at~t bc above irfformation is correct ~ad that I have read and :understand the Information Notice to Property Owners about Construction Responsibilibcs on tile <br /> <br /> Site eva]ulifion$, ~epfic, elearlcal, pluathing and mechanical work require serrate ~r~. Cheek with M~ion County Bffil~ng I~aio~ ~fote s~bllfitfing this ~pllcatlon. <br />MC 15-80 Rev, 1~2 <br /> <br /> <br />