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FOR CITY~ <br />Recetved By: '~ . . ./~2~~. <br />IZoning Validfition) -- <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 <br /> Salem, O~'egon 97301 <br /> " g:oo"m4 ~m r~.e ssg-s~4? <br /> 14 hr. lns~ecUon Line 373-4427 <br /> FAX $88-7948 <br /> <br /> FOR CITY USE ONLY <br /> <br />t .,glg: i/ <br /> <br />ONE & TWO FAjMILY DWELLING PERMrI3 APPLICATION <br /> *Includes electrical, mechanlca~ plur~g fees <br /> <br />Detached Oaxage Height: ....... ,n~ ~o.~drooms: <br /> <br />(~"~ New Single Family DwallingWith Attached Garage <br />( ) New Singl~ Family Dwelling With Detaehed Garage <br />I ) New Duplex <br /> <br />LOCATION OF INSTALLATION <br /> <br /> ~v~ Well ( ) S~nI <br /> 7 <br /> <br />CONT~CTOR INEO~TION ~ P~AS~ IN~ICAT~ <br /> <br />() <br /> <br />(please Fin0 <br /> <br />4. FEE SCHEDULE <br /> <br />VALUATION - Based on square footage: <br /> <br />Oro,;SqFt I ~'tT1 x $.345/sqff <br /> <br />1. Permit Fee (A-l) <br />2. State Surcharge (5% of A-l) <br /> <br />3, Plan Review Fee (A~2) <br />4. :Zoning Surcharge <br />5. [nvestigetion F~e ($.345 per sq ft) <br /> <br />~g q3. SI <br /> <br />=$ <br /> <br />Dwelling labels must be obtained at Marion County Bui)dlng Inspection and must be placed at the jobsite prior to inspection for plumbing, electrkml and <br />mechanical work. Contact Marion County for instructions. <br /> <br />1 hereby certify that the above information is correct. Permits are non-transferrable and expire if work is not star, ed within 180 days of issuance or if work is suspended for <br /> <br />Name of Applicant (Please Print): ~ Phone: <br /> <br /> /'3 ..... u · <br /> <br /> <br />