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F~)R CITY VALIDATION <br />ReC.~.. By: .~/~) <br />[Zofimg Valid3fion: <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 585-$147 <br /> 24 hr. Inspection Line S88-7904 <br /> FAX 588-7948 <br /> <br /> ONE & TWO FAMILY DWELLING PERMIT APPLICATION <br /> *Includes electrical, mechanical plumbing fees <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br />FOR CITY USE ONLY <br /> <br />(~New Single Family Dwelling ~ <br /> <br />( ) New Single Family Dwelling With Detached Garage <br /> <br />( ) New Duplex <br /> <br /> ~JUL ~-'9 199S <br /> MARION COUNTY <br />.mm,! I~lUa IIdQPC~.Tlflld <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />St, r~g () <br /> <br />3. CONrRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> (p]ea~ p~) <br /> <br /> NMTlmg Address <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> <br />B. PERMIT FE~S <br />1. Permit Fee (A-l) = $ Ot~)3. ~oe'~ <br /> <br />Dwelling labels must be obtained at Marion County Building Inspection and must be placed at the jobsite prior ta inspection for plumbing, electrical and <br />mechanical work. Contact M~0~County for instructions. <br />I hereby certify that the above ~aform~fion is correct. Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for <br />180 days. <br /> <br />MC 15-80 Rev 1/95 <br /> <br /> <br />