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Received By: ~ f~ 285 Church St. NE- Room 132 <br /> <br /> · . . ~ ~ [ Salem, Oregon 97301 <br /> Zoning Valtdat~on: ~ [ 8:00am-4:3Opm Phone 588-5147 <br />IDate: /-,/~7/--~:~ 24 hr. lnsFPeeA~i;~8_L~;:i?3.-4427 <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical, plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 41. JOB DESCRIPTION q?~"~l~ <br /> <br />ii FOR CITY USE ONLY <br /> otYntT;R;qTeai~ :Rear: <br /> eR Side: ~/ <br /> <br />New Single Family Dwelling With AUached Garage <br /> <br />New Single Fan~ly Dwelling With Detached Garage <br /> <br />New Duplex <br /> <br />MARION COUNTY' <br />BUILDING INSPECTION <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />I No. s,o . IDotacl dGarageHeight: <br /> <br />I MaRing Address <br /> <br />Othen <br /> <br />PhormNo. <br /> <br /> Tax Acct. NO. ~/~ ~/ <br /> Lot 7 cMffPmef ~ Block ~ <br />~.e ~ ~ War. Supply: <br /> ~vat~ Wail ( ) Spring <br />l~g.~t ~ Co~uni~Wcll ( ) Ci~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE W~I-IO IS DOING TIlE WORK <br /> () <br /> <br />( ) 1 am an AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br /> <br />Nalno <br /> <br />Mailing Addles <br /> <br />4. FEE SCHEDULE <br /> <br />Ao <br /> <br />VALUATION - Baaed on square footage: <br /> Gross Sq Ft ~ x 64.66 <br /> Garage Sq ft ~;~O x 16.27 <br /> <br /> TOTALS: <br /> <br />1, PERMIT FEE: <br /> GrossSqFt /~ x $.345/sqa <br /> <br /> TOTAL $.345 PER SQ FT <br /> <br />2. PLAN REVIEW FEE: <br /> <br />B. PERMIT FEES <br /> <br />2. Sta~e Surcharge (5% of A- I ) =$ <br />3, Plan Review Fee (A-2) -- =$ <br /> <br />6. ~in~ction Fee $25.00 = $ <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 /> <br />I hereby cerfi~ that the above information ~s correct. Permits are non-transferrable and expire if work is not started within i80 days of issuance or if work is suspended for <br />180 days· <br /> <br />Name of Applicant (Please Print): t Phone: <br /> <br />MC 15-80 Rcv lt96 <br /> <br /> <br />