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FORe, CITY VALIDATIONI <br />· ~e~d By: <br /> Zoning Vali.datipn: 0-,3 <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br />COMMUNITY DEVELOPMENT CENTER I -- -- ~ <br />285 Church St. NE - Room 132 [City Satbadr P,~quimm~t~: <br /> Salem, Oregon 97301 l <br /> ' 8:ooam,~r~0pmph0nnSS~-s~4? . [p'or~: 0~) Rear: I ~' <br /> ~ ~ 24 hr~ lltsPectinn Line 373-442'/ ~Lel~ Si~. ~" [Rio],, Sin,. ~' <br /> FAX 588-7945 I ' "' I~'- <br /> <br /> ~ ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes ~r~q~ ~l~O~t pt~ <br />COMPLETE ALL SECTIONS' 1 THROUGH 4L ,/OB DESCRIPT{ON I [t~'~ ~1 el <br /> ( )NewSin'gli~tamilyl)w~llingWithAt~achcdGamge ¢.n~f,~ ~R 1 /~ s~ <br /> O~ NeW Sing% Famil~ Dwelling ~ <br /> ( )NewOuplex MARION COUNTY <br /> <br />m.I hi,ir. !NSPEOTION <br /> <br />2. LOCATION OF INSTALLATION <br /> Proper~ owner S ~ ~( ~-~ <br /> <br />I Mailing Address phone No. <br /> <br />Block <br /> <br />Wat~' Supply: <br />Private Well ( ) <br />CommunityWell ( ) <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />Spfin~ <br />City <br /> <br />( ) I am the PROPERTY OWNER and own, reside in, or will reside in the completed stractum and will be my own general contractor. I und~ts~md that I must regismr as a comtngfion <br /> <br />() [ <br /> <br />P'egistrati°n N~ 0 ~) ~ <br /> <br />4. FEE SCHEDULE <br /> <br />An <br /> <br />VALUATION - Based on squar~ foe e: <br /> <br /> Garage Sq ff x 16.27 <br /> TOTALS: <br /> <br /> Mechanical ~ .022 per sq <br /> TOTAL $.345 PER SQ ~ <br /> <br />B. PERMIT FEES <br />L Perr~t Fee (A-l) <br />2. State Sumharg~ (5% Of A-l) <br />3. Plan Review Fee (A-2) <br /> <br />4. Zoning Surcharge ($20.00 if applicabl~) <br /> <br />5. lnvasilgation Fee ($.345 p~r sq fi) <br /> <br />6. Reinspection Fe~ $25.00 <br /> <br />7. Other inspection $40.00/per hr (1 hr min.) <br /> <br />8. Overlime inspections $40.00/per hr (2 hr min.} <br /> <br />Dwelling labels must be obtained at Marion Courtly Building Inspection and must be placed at the jobsite prior to inspection for plumbing, el~trical and <br />mechanical work. Coniact Marion County for instructions. <br />I hereby certify that the al~e info .r[aation is correct. Permits ~ non-transferrable and expire if work is not started within 180 d. ay~f issuance or if work is suspended for <br /> <br />Signature ° f Applicant: ~K~L~/'-N~" (~ ~ Date: <br /> <br /> <br />