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FoR~OFF[CE USE ONLY <br />Received By: <br />Zoning V~idation: <br />Da~c: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 Higl3 Street NE <br /> Salem, OR 97301 <br /> 8:00am.4:3Opm Phone 558-5147 <br /> FAX 588-7948 <br /> <br />ONE & TWO FAMILY DWELLING PI~RMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. Job Description <br /> <br /> FOR OFFICE USE ON. LY <br />I City Setback P.~q~irernents: ,, <br /> <br />( ) New Single Family Dwelling w/garage ( ) Garage, attached <br />(A/) New Single Family Dwelling w/o garage ( ) Garage, detached <br /> <br /> / <br /> <br />Tru,s<)Q orRafter( ) INo,$torles / ]DetaehodGarageHeight: ~)O~O~ IN°'Bedr°°ms: / <br /> <br />  ~.,.~r~ tt'l <br />2. Location of Installatlon ~, <br /> <br /> /~V' <br />3. Contractor Information <br /> <br /> ~ I unders~nd ~at I mint reDster ~ a ~mtm~on con~a~ ff me s~a~* is sold ~ offer~ f~ S~e ~fore or u~n ~plefion. <br /> (~ I will ~ my own general <br /> <br />~ I hJ~ ~u~n~a~t~ I will ~ only ~u~on~ r~gi~t~ wi~ &~ ~ns~ion Con~o~ B~d. ~ I ~ ~ ~n4 ~d do ~ a g~ ~ntr~ <br /> <br />who ~ ~gJsrer~ wi& &~ Con~ion <br /> <br />Contractor Business nan~ & #: ] Mailing Address: .' [ Phone: <br /> ( ) I am a ~egiste~ed builder OR lhe authorized repre~entatlve of a registered builder, <br /> <br />4, Fee Schedule <br /> <br />A. New One~and~Two Family Dwelling Code <br /> (inlmdem FA, Me, PI) <br /> <br />(1) Orc~$ Sq. Ft. ~ x $,28 <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) Plan Revlew <br /> <br />(4) Zoning Surcharge ($15 if applieabl~) <br /> <br /> I hereby certify that the above information is ~¢,rreet and that I have rc~ut and understand the Information Notice to ~operty Owners about Construction Responsibilities on <br /> <br />S gnature of App cant: ,,~ ~ff~~ Date: /[ <br />Site evaluations and septic work reqmre serrate ~mts, Cheek wi~ M~ion County B~lding Ins¢~ion ~f~e subnfitfing tiffs <br />MC 15-80 <br /> <br /> <br />