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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00ara-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />Iro' FOR CITY USE ONLY <br /> <br /> ty Setback Rcqulr~mems: <br /> <br /> .,: / Re : 5''-/ <br /> fiSide: ~/ ~tSid~: ~a <br /> <br />ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br />1. JOB DESCRIPTION <br /> <br />*Includes electrical, mechanical, plumbing fees <br /> <br />0~) New Single Family Dwelling With Attached Garage <br />( ) New Single Family Dwelling With Detached Garage <br /> <br />( ) Now Duplex <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />3. CON~CTOR INFO~TION -- PLEASE INDICATE ~O IS DOING THE WO~ <br /> <br />( ) Spe~ng <br />( ) City <br /> <br />( ) I am an AUTHORIZED REPRESENTATI~ of the property owner or contractor, <br /> <br />Name <br /> <br />Mailing Addrcas <br /> <br />(pl~a~cpdno <br /> <br />4. FEE SCHEDULE <br /> <br />B. PERMIT FE~S <br />1. Permit F~ (A- 1 ) <br /> Surcharge (5% of A- I ) = $ ~ <br />3. Plan Review Fe~ (A-2) = s JVI.7g~' <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 ~e above infm'ma~on is correct. Permits ~ non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. ~ ~r..~'-~t~'%~J' ~ ~}~/ <br />NameofApplicant(PleasePtint): ~ ~ ~1~.~.. ,~t~.~ Phone: ff~..~,_~o~--~ <br /> <br /> <br />