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1~,, R CITY VALIDATION <br />Re~,ed By: ~ <br />Zoning Validation: '7'- <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:3gpm Phone 588-$147 <br /> 24 hr. Imp,etlon Line 373-4427 <br /> FAX 588-7948 <br /> <br />FOR CITY USE ONLY <br /> ~t Side: ,~ ~0 <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanica~ plumbing fees <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRI/PTION <br /> ( i~ew Single Family Dwelling With Attached Garage <br /> ( ) New Single Family Dwelling With Detached Garage <br /> <br /> ( ) New Duplex <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> ho.eNo. 2o 9oVa <br /> <br /> Block <br /> <br />Water Supply: <br /> <br />Cotranunity Well ( ) City <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> 3o¥- <br /> <br /> (pl~s~ y~nO <br /> <br />I am an AUTHOI~ R~p~JNTAI2V~ of the pruper~ ovmer or contractor. <br /> <br /> Mailing Address ,~ t~i.~ H~ne <br /> <br />4. FEE SC~DULE <br /> <br />VALUATION - Based on square f~tage: <br /> <br /> ~ssSqFt ~ x $.345/~a $ ~ <br /> <br /> reVAL $.345 PER sO ~ <br /> <br /> GmssSqFt ~ x $.12/sqfl $ ~ <br /> <br />2. State Sunthoxg¢ (5% of A-I) <br /> <br />7. Other insp~tion $40.00/per hr (I lw min.) <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 />I hereby eertlfy that the~above information is correct. Permit~ are non4ransfermble and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. <br /> <br />SignatureofApplicam Date: ~ --~-~"~ ~ <br /> <br />MC 15-80 ~ 1/96 <br /> <br /> <br />