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iF(~R OFFICE USE ONLY <br />Received By: ~ <br />Zoning Vali_tzlatiot~: ' ~_~, <br />Da :, ,, <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 220 ltigl~ Sm~et NE <br /> Salem, OR 97301 <br /> g;00am-4:30pm l~one 55g-5147 <br /> Code-A-Phone S88-7904 <br /> FAX 585-7948 <br /> <br />ONE~ & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 *rHROUGH 4 <br /> <br />I. Job Description <br /> <br />FOR OFFICE USE ONLY <br />City Setback geatuirelnent~: <br /> <br />~ft Side'. ~ t I ~t Side.. ~ ~ <br /> <br />,RECEIVED <br /> <br />( ~5/New Single Family Dwelling w/garage <br />( ) New Single Family Dwelling w/o garage <br /> <br />( b~Garage, attached <br />( ) Garage, detached <br /> <br />Truss ( I~' or Rdter ( ) I No. StONes / ['Detached Garage Height: <br />Squa~o Feet: B~ement: } Main Floor: //..~O.~. } Seeolld Ploor; <br /> <br />2. Loratio. of Installation <br /> <br />MoNle Ho~ ~k S~ee ~ <br />, Co~n~ty Well ( ) City <br /> <br />3. Contractor Information <br /> <br /> ( ) I understand fl~at I mt re,star ~ a eo~m eon~aetm ff ~e s~e is sold ~ off~ f~ sal~ ~e ~ u~n eo~lefion. <br /> <br />4. Fee Schedule <br /> <br />A, New One-and-Two Family Dwelling Code <br /> (ild~de* BI, Me. PI) <br /> <br />{I) Gr~u Sq. k~.. <br /> <br />(2) 5% Stat¢ Surcharge (.05 xA1) <br /> <br />(3) ?lan Review <br /> <br />= <br /> <br />(1) Driveway w/curb @ $7.50 · <br /> <br />(4) Inves0gation Fee <br /> <br />(~) Reiwnw-.etJon Fee @ $2~,00 <br />(~) Other Inspections not listed above <br /> <br />x$40= <br /> <br /> I hereby certify that the above inl-ormatio~ is correct and that I have read and understand the information Notice to Preper~y Owners abo~lt Constmctio~ Responsibilities on the <br /> reverue side of Ibis form. <br /> <br /> Site ovaluatioas, ~epfie, eloc'tricaI, DlurtJbing alld mecbanleal work require $~l~.rate p~rmit& Check with Marion Co~tlty Building Inspection befor~ ~ubmhting this ,~plicatJon. <br />MC 15-80 R~v. l/gZ <br /> <br /> <br />