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~,OR CITY VALIDATION MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY <br />l~cqived By: ~ COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 2ity ~thack <br />Zofii~g Validation: z~ .~a!em, Oregon 9730 <br /> <br /> 8:00am4:30pm Phone 588-$147 <br /> Z4 h~. Inspection Line37~M27 <br /> FAX 588-7948 ~ <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICAT~ <br /> plumbing fees <br />COMPLETE ALL SECTIOi~S. 1 THROUGH 4 4~a <br />1. JOB DESCRIPTION ' ~J~ --.~/~e <br /> <br /> (~ New Single: Family DweHing~With Attaehad Garage <br /> 4 ) New Single Family Dwelling With Detached Garage <br /> ( ) New Duplex <br /> <br />Energy Path: ~ { No, Smiles ~ <br /> <br />2 LOCATION OF'INSTALLATION <br /> <br />spring ( ) <br /> <br />[mg, tI com I pfi wdl <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />1 am the PROPERTY OWNER and own. reside in. or will resid~ in the complet~ stmcmr~ and will be my own general contractor. 1 understand that I must ~gi~ter as a ~onstm~uou <br />contractor if the st~cture is sold or offered for sale befo~ or upon completion. If I hire subcontractors, [ will hire only subcontrac~ registered with the ConaUuction Conimaetor~ B~rd. <br />If I chang¢ my mind and dp him a general conlmcl~r who is registered with the Constmedon Conlractors Board, I will immedial~ly notify' Marion County of thc nmme of the contragto~. <br /> <br />I am a CONTRACTOR r~gist~red with the Stat~ of Oregon, <br /> <br />() <br /> <br />() <br /> <br />I am ap AUTHORIZED REPRESENTATIVE of the property owner or contractor. <br /> Name <br /> <br />Phon~ <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on squar~ footage: <br /> <br /> Garage Sq ft~'~ x 16.27 = <br /> <br /> o~ * Build~g ~ .185 p~ sq R <br /> <br />2. PLAN REVIEW FEE: <br /> <br />B. PERMIT FEES <br /> <br />2. State SUrCharge (5% of A-I) ~ $ ~ <br />3. PI~ ~vi~ Fee (A-2) __ · = S /p~, FY <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior to inspection for plumbingo electrical and <br />mechanical work. Contact Marion County for Instructions. <br /> <br />I hereby certify thai the above information is correcL Permits am non-transferrable and expire if work is not s~arted within 180 days of issuance or if work is suspended for <br />180 days. <br />Name of Apphaant (Please Print):~f ~ ~./~. ~! Phone: 07~ Y-- ~//f~Y <br /> <br />MC 15-80 Rev 1/96 <br /> <br /> <br />