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.................................... ] MARION COUNTY BUILDING INSPECTION ............................................................ <br /> I~R CITy.USE ONLY, I ~ COMMUNITY DEVELOPIvI~T CENTER FOR CITY USE ONLY <br /> Pax~iv~d By:~ Date: lO ~' !~'%q~/ 3150 Lancaster Dr. NE -/[~i~e~;ra ,_ /fi~ Cit- Setbac'-- <br /> <br />............ , ....................... ; 24 hr. Inspection Line 3;q~27~ ? '~ [~l~:'7~Y~ <br /> FAX 588-7948 lid. ~ ;'"'4~q"t'l'l'i ....................................... <br /> ONE ANO TWO FAMILY DWELLING PERMIT APPLICn.TIb{q ! .8 ~t,,,_ 'WJl/i <br /> <br /> Dwelliag labels must be obtained at Marlo. Couaty Building inal~efion lad mast tie plaeed at t h ,?o~110~ ~r plumbllg, el~ieal lad <br />work. Contact Marion County for instructions. -' "OMFl~"r. ....... <br /> N "~'/10! <br />1. JOB DESCR1PTIO <br /> <br />{~) New Single Family Dw¢lting with ARached Garage <br /> New single Family Dwclting with De-tached Garage <br /> <br />Square Footage: Basement: ~~... 2nd Floor: <br />LOCATION OF INSTALLATION <br /> <br /> ) New Duplex With A~ached Garage <br /> ) New Duplex with Detached Garage <br /> <br />Oth~: Garage: i/~ #Stories: ~ Un~: ] <br />Drilling Height: Garagg l~ight: <br /> <br />3. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS DOING THE WORK <br /> <br />() <br /> <br />I am the AUTHORIZED REPRESENIATIVE of the property o~r or the contractor. <br />Business Name (please print) ,~/q <br /> <br />Mailing Address: ,~ Street <br /> <br />IamacoN~RACTORregistctedv/i~th¢Stat¢ofOreggn. , n · a <br />Business Name (pleas~ prim): ~ t ~ ~- Rogistralion #: ~J~__ <br /> <br />4. FEES <br /> <br /> VALUATION (See Valuation Schedule to determine the valuatiml bas,d on square <br /> fcotage) <br /> Liv/ngArea Squ~reFeet/~(x $64.66 = $ ~O~i~O <br /> GarageSqvareVeet ~ x $16.27 = $ ~,~,'~ I <br /> <br /> *************************************************************************** <br /> A. 1. Permit Fee: re~g g~ <br /> Gross Square Feet x $0.4050 = $ ~, / ~ <br /> <br /> Building ~ $0.185 per square foot <br /> Electrical ~ $0.090 per square f~t <br /> M~chanical ~ $0.040 per square foot <br /> Plumbing ~ $0.090 per square foot <br /> <br /> 2. Plan Review Fee <br /> GrossSquar~F~t ]9~}Jr x $0.120/sq.r,=$ Z39,7 , <br /> <br />Fee Summary <br /> <br />(2) State Surcharge (.05% x A-1 ) <br />(3) P~ Review F~ (A-2) <br />(4~itio~ P~ ~/~m ~ $50~, <br /> m~i~m o~fbour. <br />(4) Zon~g Surge, if a~li~le ($30.00) <br />(5) lnv~fi~ F~ ($.4050 ~ ~. ~.) <br />(6) r~ F~, $50.00 <br />(7) I~iom ~de ~ of ~1 <br /> bus~ h~ $50~, ~ ~ hou~ <br />(8) ln~ ~ wh~ ~ ~ ~ ~ <br /> iMi~ $~.00~, ~m ~ h~ <br />(10) F~ ~y Au~ $25.~ <br />(11) ~Rional S~ ofPla~ $10~ ~ <br /> <br />I hereby certify that the above information is correct. Pem6ts are n~-transfimable and e~.ir e if work is n~ started within 180 d~s of issuance or if work is suspended ~r 180 days. <br /> Nam~ o f Applicant [PI~i~ Print]: ' .~[~ , ' <br /> Mailing Address: <br /> <br />Signature of Applicant: <br /> <br /> <br />