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FOR CITY VALIDATION <br />I{ecei,,'e~ By: -~' ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 58g-5147 <br /> 24 hr. Inspcetlon Line 588-7904 <br /> FAX g88-7948 <br /> <br />FOR CITY USE ONLY <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLIC~T_~N <br /> *Includes electrical, mechanics. I, plo ,nbing_f~q~ <br />COMPLETE ALL SECTIONS. 1 THROUGH 4 <br /> <br />!.. JOB DESCRIPTION <br /> ( )NewSinglePamilyDwelllngWithAttaehedOarage \~x~ ,.. Qg '~ <br /> <br /> / <br />2. LOCATION OF INSTALLATION <br /> ~o~y ow.e~ x~J~,e,~T~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ( ) I am a CONTRACTOR wgi~tered with th, St~t~ of Oregon. <br /> <br /> ( ) I am an AUTHORIZED REPRESENTATrVE o f th~ prol~rty owner or contractor. <br /> [ Nam~ <br /> <br />4. FEE SCHEDULE YALUATION: <br /> <br /> 2, PLAN REVIEW FEE: . , 3~ 9, Foo6ngf~oundation Only $25,~)0 - Cou.~J;y <br /> <br />Dwelling labels most be obtained at Marion County Building Inspection and must be placed at the johsite prior to inspection fo~ plumMng~cal and <br />mechanical work. Contact Marion Connty for instructions. <br /> <br />180 days, <br />Name of Appllca,, (Please Print); ~1~ W ~a~ ,,, Phone: ~,,,~0~ <br />Sig,ature of Applicant: _Date: <br /> <br /> <br />