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us¥ I <br />Received. By~ <br />Zoning Validation f <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Sm:et NE <br /> Salem, OR 97301 <br /> g:(!Oan-4:3Opm Phone 5g$-$14~ <br /> Codo-A.Phon6 588-7904 <br /> FAX $88-7948 <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br />COMPLETE ALL SECTIONS, 1 THROUOH 4 <br /> <br />1..Ioh Description <br /> <br />~SE ONLY <br /> City Sc~hack R~quirement~: <br /> <br />( ~'Ncw Single Family Dwelling w/garage <br />( ) New Single Family Dwelling w/o garage <br /> <br />( 0'~3arage, attached <br />( ) Garage, detached <br /> <br />Truss ( ~ or Rafter ( ) No. Stories / Detached Garage Height: No. Bedroontn: ,~--'~ <br />2. Location of I ~ ~.~/~,.~ F2~/~'~T <br /> <br />3. Conlractor Information <br />gropertyOwnet ~ ~ t~'f~4~ IMailingAddre,s IPhon, No. <br /> ( ) I own, renide in. or will reside in the completed structure. <br /> <br /> ( ) I undarstand that I mu.it register ~_q a cons ruction contractor if the stru~Ulre is ~o d pr offored for sale before or upon completion. <br /> (~ I will be my owll general oontraetor. <br /> <br />If I hire :mbeontractors, I will lair. only subcontr~tors registered wi~h the C. onstraction Contractors Board. Ill change my mind and do hire a g*netal contraatc~ <br />who ia registered with the C.onstmction Contractor's Boa~d. I will ir.nmodiately notify Marion County of th. name of the contraeor: <br /> <br /> ( ) I am a roglstetad builder OR file m~ori~ re~ontafivo of a regisIered ~ldg. <br /> <br />I Mailing Addressi I Phone; <br /> <br />4. Fee Schedule <br />A. New One-and-Two Family Dwelling Cede <br /> (inleud~ El, Me, <br /> <br />(1) Gross $q, Ft.., x $,211 <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(4) ZOo/nd Surctiarge ($15 if applicable) <br /> <br /> B, Miscellaneous <br /> (1) Driveway w/curb @ $7.50 <br /> <br /> (2) Driveway w/o c~b @ $17.00 <br /> <br /> (3) Additional Plan R*views or Addendurn~ <br /> <br /> (4) Investigation Fee <br />= 185.00 (5) Reinspecfion F~e @ $25.00 = <br /> ~)l,'- f / (6) Other inspections not listed abov~ = <br /> <br /> l h~reby certify that the above itfforrnation is correct and that I have read a d understand fle Information NcnJce to l~y Owners a~t Cons~ucfion Raq)onsibilifies on the <br /> reverse ~ide o/this f~nl. <br /> <br /> Sigl,atureof Applicant: . ~~ ~(~e~ Dar*'/~/~fS * <br /> S~le ewdua ohs, sepuc, ele~cal, p umb ng ~d mechan ca work ~qmre serrate ~r~. C~ck w & M~ o~ County ~Iding I~ ou ~forc. mbmRfiug thi~ ~pSea6on, <br />MC 15-80 Rev, 1~2 <br /> <br /> <br />