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FOR CITY VALIDATION <br /> iv By: ] <br />Zoning Validatio::~ ~'~-. <br />Date: ~-~.~ q~' ' <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 588-$147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />[oFOR CITY USE ONLY <br />~siti%j~o ' ~Side:~ ~ <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> ( ~New Single Family Dwelling With A~ached Garage <br /> ( ) New Single Family Dwelling With Detached Garage <br /> ( ) New Duplex <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includeselectrical, mechanical, plumbingfees <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />No. l~drooms: ~e~ <br />Other: <br /> <br />Phone No. <br /> <br />City <br /> <br /> Block <br />Zone ~5 Map.~ Water Supply: <br /> Private Well ( ) Spring <br />hxeg. Lot Comer ,e¥~__~e~ Community Well ( ) City <br /> <br />3. CON, TRACTOR INFORMATION ~ PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />g I am a CONTRACTOR mgJatemd with the Sm~ of Oregon. <br /> <br />Marne <br /> <br />4. FEE SCHEDULE <br /> <br />oarage Sq ft _~g~l¢O x 16.27 $ <br />TOTALS: /,~'~0 = $ <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 instructions. <br /> <br />I hereby certify that the above information is correct, permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />lg0 days. <br /> <br />Signature of Applicant: Date: & - ~-- / ~ ~ <br />MC 15-80 Rev 1/96 <br /> <br /> <br />