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onin~ Validation: ~1~ I <br />ttte: I <br /> <br />MARION COUNTY BUILDING INSPECTION I FOR CITY USE OlaY I <br /> COMMUNITY DEVELOPMENT CENTER I ?,4./' I <br /> 285 Church St. NE - Room 132 I¢iw s~ R~q~: x~)~ <br /> ..... Sal~m~, Or~gon 97301 F ~- <br /> <br /> , ' ! < :M hr. Impgefl0n Lln~ 373-tM27 : ~ ~e Side' ~] ~ght Side: <br /> <br /> :: ; ~ ONE & ~O,F32~41LY DWELLING PERMIT APPLICATION <br /> <br /> · , , *lucludeselectn'cal, mechanical, Plumbing fees l~fffiV[D <br />COMPLETE ALL SECTIONS, 1 THRouGH 4 : ' <br /> <br />L Jo. DESC~n'T,ON ~"153 t q O~ ...~ · . .~ <br /> <br />M~RION COUNTY' <br />BUILDING INSPI;OTION <br /> <br /> (~ New Singleqqamily Dwelltng~With Attached Garage <br /> (') New Single ~an~ily Dwelling With Detached Garag~e <br /> ( ) New Duplex <br /> <br />Energy Path: I No. Sto~es I I l~taeh~dGarageHeight: <br /> <br />Spring <br />city <br /> <br />Business Name R~gistration No. <br /> <br />;a2: AUTIIORIZED REPRESBNTATIV' °' t Pr°P~nY °w~r t ~°ntra¢~ <br /> <br />4. FEE SCHEDULE <br /> <br />(please palm) <br /> <br />VALUATION - Based on squa~ Lta~gfoota e: <br /> <br /> Garage Sq ft ._"~ ~ ~ x 16.27 <br /> TOTALS: ~,~ <br /> <br /> TOTAL $.345 PER SQ FT <br /> <br />CJ-rq <br /> <br />=s 19,q~ <br /> <br />=$ <br /> <br />=$ <br /> <br />=$ <br /> <br /> ql,6; <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobslte prior to inspection for plumbing, electrical and <br />mechanical work. Contact Marion Count) for instructions. <br />1 hereby certi~ that the above infotmauon ~s correct. Permits are non-lransfetrable mad expire if work is not stared within 180 days of issuance or if work is suspended for <br />180 days. <br />Name of Applioant (Please Print):.~ ~/~ ~ .'~~ Phone: (~-O~) ~"~ ~-"~ -'~C~ _~ <br /> <br />MC 15-80 Rev 1/96 -- <br /> <br /> <br />