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FOR CITY USE ONLY <br />Received ~By: <br />Izoning Validation: <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 /> Code-A-Phone 588-7904 <br /> FAX 558-7948 <br /> <br />FOR CITY USE ONLY <br /> <br />City Setback Requirements: <br /> <br /> 5_/ <br />Left Side~ / ~ght Si~: f / <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Iob^ e. /0001 C b_ rZ-Ln,,/d T,^cc...o. qd/r n/7/ c o..s t <br /> <br />~fion ~ Town,hip ~ ~ge ~ ~ ~ne ~,~, M,p ~--D.~. W.rSupply: <br /> ~vateWell ( ) S~ng ( ) <br />~tWi~ 7~ ~t~p~ /~ Ae~ l~g. ~t Comer Co~uni~W*ll ( ) Ci~ (~ <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> ~Iam the PROPERTY OWNER and own. reside ha, or will reside in the completed structure and will b~ my own genera[ contractor. I understand that I must register as a construction <br /> <br /> ( ) I am a CONTRACTOR r~gister~d wlth the Stat~ of Oregon. <br /> <br /> Ma/ling Addr~s: (pi ~se pdnt) <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION: <br /> <br /> (minhnum $2,000) <br /> <br />(See Table No. 3-A) <br /> <br />B. PERMIT FEES <br /> <br />Plan R~viewFee (65% x B-l) =$ <br />Investigation Fee = $ <br />Reinspectlon Fee $25.00 = $ <br />Other inspections ($40.OO/l~r hr, mhaimum 1 hour) -- $ <br />Overtime inspections ($40.00/per h~, minimum 2 hours) = $ <br />TOTAL = $ ~ <br /> <br />I hereby certify that the above information is correct. <br />Permits are non-transferrable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. <br /> <br />Name of Applicant (Please Print):._ / <br /> <br />Signature of Appllcant: <br /> <br />MC 154)4 Rev3/95 <br /> <br /> <br />