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MARION COUNTY BUILDING INSPECTION <br /> .220 High Street NE <br /> Salem, OR 97301 <br /> $:00am-4:30p/n Phone 588-5147 <br /> Code-A-Phone 588-7904 <br /> FgX 588-7948 <br /> <br /> ONE & TWO FAMILY DWELLING PERMrF APPLIC.ATJLON <br />COMPLETE ALL SECTIONS, 1 THROUGI4 4 <br />1, ,'[ob Description <br /> <br />( ~/3/New Single Family Dwelling w/gamg& <br />( ) New Single Family Dwelling w/o garage <br /> <br />~O~,FFICE USE ONL.~Y <br /> <br />[Left Side: ~.~t Eight gide:~,~TM <br /> <br />2. LocationoflnsLallation ~ ~ % ~ q ~'~a~' <br /> <br />, Job Ad~re~s : ....... ~ite No. ' ............ <br />Mo~le Ilome P~k S~ee ~ <br /> PrlvateWell ( ) Spring <br /> <br />Contractor Illformation <br /> <br /> ) I own. r~side in. or will reside in t~ completed s~e. <br /> <br /> ) I will ~ my own general contra~. <br /> <br />If I hire subcontractors, I will kite only subcontractors registered with the Conatruclion Contractors Beard, ff I change my mind and do ltire a general contrac'tc~ <br /> <br />who is reglatered wilh the Constraction Contractor's Board, I will immediately notify Marion County of the name of the contracor: <br /> <br />4. Fee Schedule <br />A. New One-and-Two Family Dwelling Code <br /> (inleudes El, Me, <br /> <br /> (2) 5% State Surcharge (,05 x Al) <br /> <br /> (3) Plan Review <br /> <br />Valuation: <br /> <br />= $isg.0o <br /> <br />Miseellane~q Fees <br /> <br />(1) Driveway w/curb @ $7.50 <br /> <br />(2) Ddveway w/o curb @ $17.00 <br />O) Additional Plan Reviews or Addendums <br />(4) Investigation Fee <br /> <br />(~) Reinsl~cfion Fee @ $25,00 <br />(6) Oflaer Inspecdons no~ listed above <br /> <br />...... x$40= __ <br /> 'l-OT^ $ AAA'. <br /> <br /> <br />