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FOR CITY VALIDATION <br />Received By: <br />~oning Validation: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, Oregon 97301 <br /> 8:00am-4:30pm Phone 588-5147 <br /> 24 hr. Inspection Line 373-4427 <br /> FAX 588-7948 <br /> <br />City Setback Requtrements: <br /> <br />FOR CITY USE ONLY <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 />()~) New Single Family Dwelling With ARaehcd Garage <br />( ) New Single Family Dwelling With Detached Garago <br />( ) New Duplex <br /> <br />MARION COUNTY <br />BUILDING INSPECTION <br /> <br />LOCATION OF INSTALLATION <br /> <br />[ M~li~Ad,~ gdd.~-t4 ~Z. '~l <br /> <br />city <br /> <br /> Tax Acct. No. <br /> <br />zo.~ ~.,5 <br /> <br /> Comer <br /> <br />Block <br /> <br />Water Supply: <br />Private Well ( ) Spdng <br />Community Well ( ) City <br /> <br /> Irreg. Lot ~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />Marling Addr*ss <br /> <br /> Phone <br /> <br />4. FEE SCHEDULE <br /> <br />B. PERMIT FEES <br />1. Permk Fee (A-I) =$ ~ <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 celMfy that the above information is correct. Permits are non-trans ferrabl~expire if k is not started v¢ithin 180 days of issuance or if work is suspended for <br /> 180 days.~ <br /> <br />MC 15-80 Rev 1,96 <br /> <br /> <br />