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FOR CI.T~Y VALIDATION <br />Received By: <br />Zoning Validation: <br />Date: //'~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNIICY DEVELOPMENT CENTER <br /> 2~5 Chumh St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> g:00am-4:3§pm Phone 588-5147 <br /> 24 hr. Inspection Line 373-4d27 <br /> FAX 588-7948 <br /> <br />FOR CITY USE ONLY <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLI~.~..TtI~-- <br /> *Includes electrical, mechani~l, plumbing fe~ <br />CO~LE~ = SCIONS, I THROUGH 4 <br /> <br />1. JOBDESC~TION ~ NO~ 12 19~8 ~-~ <br /> <br /> NeW Single F~ily ~elli~g Wi~ ~ac~ed ~ <br /> mw gu¢~ BUJLBJNG INSPECTION <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />City <br /> <br />4. FEE SCHEDULE <br /> <br />~75o7 <br /> <br />Phone <br /> <br />VALUATION - Based on square footage: <br /> <br /> Oarag~ Sq fl ~x 16.27 <br /> <br />mechanical work. Conalct Marion County for instructions, <br /> <br /> L Permit Fee (A-I) <br /> 2. S~ate Surcharge (5% of A-l) <br /> 3. P~ R~iew Fee (A-2) - $ <br /> <br /> 7. O~er in~tion $40.~/per ~ ( I ~ min.) = $ <br /> <br />must be plat~ at the Jobsite prior to inspe~on for plumbing, el~tfieal and <br /> <br />1 h~by e~nif7 that the above informalion is correct. Permits are non-transferrable and expire if work is not staaed within 180 days of issuance or if work is suspended for <br />180 Says. c77'~ / __ <br /> <br />si~o~^~¢i~,~: ,,.._~,., .j -, ./~...,~ ,, . <br /> <br /> <br />