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MARION .COUNTY BUILDING INSPECTION <br /> 220 High Street NE. <br /> Salem, OR 97301 <br /> g:00am-4:30pm !~noae 5g~-514'/ <br /> Code-A-Phon~ 585.7904 <br /> FAX 588-7948 <br /> <br />ONE & TWO FAMILY DWELLING lmP, Mrr APPLICATION <br /> <br />COMPLETE., ALL SECTIONS, 1 T/IROUGH 4 <br /> <br />1. Job D~cription <br /> <br />( dNew Single Family Dwelling w/gatag0 <br />( ) NOw Single Fmnily Dwelling w/o garage <br /> <br />( ~5/Garage, attached <br />( ) Garage, detached <br /> <br />'~mss(~/ or Ran~r( ) [' r%.stode~ / <br /> <br />FOR OFFICE USE 9,NL¥ <br /> <br />2. Location of Installation <br /> <br />Mobile Home P~k S~e ~ <br />Se~Joa R~,, Towns~p '~ 5 "Range ~ ~ Zon~ ~S Map W~tet Su~ly: <br /> Pfiv~eWoll ( ) Spring ( ) <br />T'olWidth ~.~ L~ /~fl,~ Acr= l=eg,~t ~X Comer ~ Commu~tyWell( ) City (~ <br /> <br />3. Contractor lnformatlon <br /> ( ) I own, r0~id* in, m- will reside in the eompletad stmctu~, <br /> <br /> ( ) I will be my own general contractor, <br /> <br />If I hire aubco/lltactoru, I will hire only subcoatr~mtors registered with tho Con~lruction Contrlmtors Board, If I chango my nlind and do hJr~ a general cent t,%ctor <br />who i~ registered w/th the Constraotion Contractor'~ Board, I willimmediately notify M~rion County of th~ name of tho ¢ontraeor: <br /> <br /> ~(~ I am a registered builder OR the a~th0fized relXesentafivc ;;ff a registered buiiO~r. ~/~/,, ~. ~ ~f~_ ¢7o.~_~ <br /> <br />A, Now One-and-Two Family Dwelling Code <br /> (inlcude.~ I~I. Me, <br /> <br />(1> GrossSq, Ft./7~ x$2g <br />(2) 5% State Surcharge (.05 x Al ) <br /> <br />(3) H;m Review <br />(4) ,~ ......v, <br /> <br /> I herehy ceriit'y that the abova illfotmation is correct and that I llaYe read and tinders and fle Information Notice o h-Operty Owller~ al:mu Construction Respon~thihiies o0 tim <br /> <br /> .__ , ,. <br /> S~te evahmdons, aepfie, electrical, plu ruhi eclumica(wor k require seperate i~tt~, Clmek with Mari~n County Btfilding I nSl~etion before submitting this al~plieation. <br />MC 15-80 Re¥~ 1/92 <br /> <br /> <br />