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FOR CI .Y VALmATION <br /> <br />Zoning Validation: <br />IDate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMLTNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am.-4:30pm Phone 5;88-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />Lift Side: Right Side: <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br />) New Single Family Dwelling With Attached Garage <br /> New Single Family Dwelling With Detached Garage <br /> <br />) New Duplex <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />ci,~ ,6,~_o1~, <br /> <br />3. CONT~CTOR ~O~ON ~ PL~SE ~ICATE WHO IS DOING T~ WO~ <br /> <br />4. FEE SCHEDULE <br /> <br />sVi f ,q,q..Xf e. <br /> <br /> Pennlt Fee (A- 1 ) <br /> Sta~ Surcharge (5% of A-l)* <br /> Plan Review Fee (A-2) <br /> <br />Zoning Surcharge ($~0. ~00 if applicable) <br />~aua~igation Fee (5.345 per sq fi) <br />--~tion Fee 525.00 <br />~ inspe~ioa $40.00/per hr (l hr min.) <br />-'O'~ime inspections $40.O0/per hr (2 hr min,) <br />TOTAL <br /> <br />~$ <br /> <br />Dwelling labels must be obtained at Marion County Butlding Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby certify that the above information is coxrect. Permits are non4nmsfermble and expire if work is not started within 180 days of issuance or if work is suspended for <br /> <br />Name of Applicant (Please . ~~-~ Phone: ~'~ ~ ' '~-'~-1 <br />Signatex~ofAppllcant: <br />MC 15-80 R~v 1/96 <br /> <br /> <br />