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fFOR CITY VALIDATION <br /> ~eived By:, <br /> comng Vhlidat~on: <br />Irate: <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 $88-$147 <br /> 24 hr. lmpecflon Line ~88-7904 <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electt~ca~ mechanical, plumbing fees <br /> <br /> FOR CITY USE ONLY <br /> <br />L~ft Side: Right Side: <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />L JOB DESCRIlrrION <br /> <br /> J~New Single Family Dwelling With Atiacl~d Garage <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br /> ( ) New Duplex <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Lot Width ~/?f Lot l~pth ~ Acres <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING TI:I~ WORK <br /> <br /> ( ) i am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I must register as a construction <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> <br />B. PERMIT FEES <br />L Pca~mit Fee (A- 1 ) =$ <br />2. State Surcharge (5% of A-l) -- $ <br />3. Plan Review Fee (A-2) -- $ <br />4. Zonblg Surcharge ($20.00 ff applicable) = $ <br />5. Investigation Fee ($.41 per sq ft) = $ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion County for instructiom. <br /> <br />I hereby certify that the above information is correct. Permits are non-tt~msferrable and expire if work is not started within 180 days of issuance or if work is ~nded for <br />180 days. <br />NameofApplicant(PleasePrint): /~O~0~' /ff. ~--~t~O.'~Y~,~ ~ Phone: ~' 7~r~-'~,~ ~ ~ p <br /> <br />MC 15-80 R~v 1/95 <br /> <br /> <br />