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FOR CITY VALIDATION] MARION COUNTY BUILDING INSPECTION [ FOR CITY USE ONLY <br /> · // ~ ~ ] / COMMUNITY DEVELOPMENT CENTER [ <br /> R¢c~i~d-B~: ,,,,~~ [ 285 Church St. NE - Room 132 ICily S~b~k P~uir~m: <br /> ~ ~ <br /> <br /> · : ~ ONE & TWO ~M!LY D~LL~G PE~IT ~PLICATION <br /> <br />1. JOB DESC~TION <br /> <br />2. LOCA~IO~ OF <br /> <br />3. CONT~CTOR I~Fp~ATION ~ PLEASE INDICATE ~o IS DOING T~ WO~ <br /> <br />I ~tm a ~o~TRAC~OR registered with the ~tate °f Or~g°n' <br /> BuSiness Name <br /> <br /> am an ~UTHORIZED P, EPRESENTATIVE of the property owner or conwacmr. <br /> <br /> Mailing Address ..... <br /> <br />Registration No. ~ O'~g~} <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />L PERMI~ FEE: <br /> <br /> TOTAL $.345 PER SQ ~ <br /> <br />B. PERMIT FEES <br />1. Permit Fee (A-I) =$ tC~ <br />2. Stat~ Surcharge ($% orA-I) = $ Yg~* F~ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbing, ele~trical and <br />mechanical work. Contact Marion County for instructions. <br /> <br />I hereby ce~ify that thc above information is ~orrect. Permits aM n0n,transferrabl~ am] expire if work is not started within 180 days of issua~e or if work is suspended for <br />180 days. <br />Name of Applicant (Please Print): [--L..~..- Phone: <br /> <br />Date: <br /> <br />R~v 1/96 <br /> <br /> <br />