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I 'o. °me ONLY <br /> <br /> Date- _.JL=d J'-q-~" . <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 It]gl!_ Street NE <br /> ~ ~ galea~, OR 97301 <br /> <br /> Cod¢-A-l~lono 588-7904 <br /> <br />O~ & TWO )'~Y D~LL~G ~ APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. ,lob De~crlptton <br /> <br />City S~baek Requirement.q: <br /> <br />( L~ew Single Family Dwelling w/gatag~ ' :( L0~arage, attached <br />( ) New Single Family Dwelling w/o garage ( ) Garage. detached <br /> <br />[ l~taeked Garage Height: <br /> <br />faa <br /> <br />Site No, <br /> <br />Bleek ~ <br /> <br />Water Sup01y: <br />Private Well ( ) Spring <br />Community Well ( ) City <br /> <br />3. Contractor Information . · : · · <br /> <br /> ( ) I own, r,~sidc in, or will reside in thc complcted'structute, <br /> <br /> ( ) I undemand ~at I mm~ re~r ~ a ~mtm~on Con,ecrm if ~ s~c i~ S01d or off~d fo~ s~c ~fo~ m u~n eb~lefion. <br /> <br />l[ I hire subcontractors. I will hire only subcontractors registered wi~h the Constzuc'tlon Contractors Board. If I change my mlnd and ,~o ]fire ~ genera] contractor <br />who is registered wi& ~h* Construotion Con,rector% Board, I will immediately notify Marion County ot'th~ name of the oantracor: <br /> <br />~(.~)rlamar~?tercdbuilde, ORth*~th0dzedmpre,¢ntativ, ofo, tegist*r~l::nilder.... /,bt. ~:. ~,O'le~ ¢"t73,°t <br /> <br />4. Fee Schedule <br /> <br />A. New On,-and-Two Family Dwolli,~g Code <br /> m, m, m) <br /> <br />(1) Gro$, Sq. Fl, <br /> <br />(2) 5% State Surcharge (.05 x Al) <br /> <br />(3) Plan R,view <br /> <br />(4) Zor~ing Smclmxge ($15 if <br /> <br />B. Miscellan0o~as <br /> (1) Driveway w/curb ~ $7.50 <br /> <br /> (2) ~veway w/o c~b ~ $17.~ <br /> <br /> . (3) ~fiona] ~an Renews orAddendu~ <br /> (4) In~gafion Fee <br /> <br /> (6) ~her Ins~cfi~ not li~d <br /> <br />x$40-~ _ <br /> <br /> · · Phone: ~ .... <br /> <br />Site evaluation& septjc:.~le~ica~mb--~g and ~echanical work requi~ serrate ~mfi~. Check wi~ Mmon County Building I~s~ ica6on. <br /> <br /> <br />