Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION I FOR CITY USE ONLY <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room 132 [City S~aaek <br /> , Sal~, Oregon 97a0! <br /> · :' ~, 8ioo~im-4~30p~phode$~8-$i47 ' ':, , [Fro~. ' <br /> , :: , 324hr. Jnlp~flon Ctn~a~-44i'/: ' ' ~ : ' [L~flSide, Im~t Side* <br /> FAX $8$.794g I ' -- ' <br /> <br /> FOR. CITY VALIDATION <br />Received By: __ <br /> <br />Zoning Validation: <br /> <br />]Date: <br /> ~ ·: -', ONE,& TWO FAMILY DWELLING PERMI-T APPLICATION <br /> <br />COMPLETE ALL SECTIONS, 1 THROUGH 4 <br /> <br />1. JOB DESCRIPTION <br /> <br /> ( )'N~w Singl~ Family Dwelling With Detached Garage ~ ~ ~0~'" <br /> <br />2. LOCATION OF INSTALLATION 00na"S V ,'11¢,,, 0 I~ <br /> ' '/6'/L'/ 'Z e P& I m v,'lIs. <br /> <br />spri~ <br /> <br />Lot Width LotO th / <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br /> ¢ ] ] am the PROPERTY OWNER and own. reside in. or will reside in the completed structure and will be my own general contractor. I understand that I must register aa a constmb-thm <br /> contractor if the swaeture is sold or offered for sale before or ugon completion. If I hire subcont~'aetor~. I will hire only subconvractors r~gi~'~ed with the Coestmction Coelractors Beard. <br /> <br />( ) 1 am an AUTHORiZeD REPRESENTATIVE of the propeay owner or contractor. <br /> <br />Name <br /> <br />Mailing Address <br /> <br />(pirate print) <br /> <br />4. FEE SCHEDULE <br /> <br /> VALUATION - Based on squar~ footage: <br /> <br />Ao <br /> <br /> C, ross Sq Ft x 64.66 $ <br /> Garage Sq fl x 16.27 $ <br /> TOTALS: $ <br />? 1. I'ERMIT FEE: <br /> <br />B* PERMIT FEES <br />I Permit Fee (A-l) ~ S <br />2 State Surcharge (5% of A-1 ) = S <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 certify that the above information is con. ct. Pormits are nomtransfermble and expire if work is not started within 180 days of issuane~ or if work ia suspended for <br />180 days, <br />NameofApplicantiPleasePrint): /t~L(lf /~Xt~a. '~-~,/~P0~ L~O~]~.) Phone: <br />SignamreofApplieant: ~'~, ~b~,e~_.,)//~._ ~ /~ia~.~7~"~J Date: <br /> £ <br /> <br /> <br />