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FOR CITY USE ONLY~ <br /> <br />Zoning By:_~City: <br />R~c~ip~ ~-~"~' ~; ~ Panoum: $ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 3150 Lancaster Dr. NE - Suite C <br /> Sa/em, Oregon 97305 <br /> 8:00 am - 4:30 pm <br /> 24 hr. Inspection Line 3734427 <br /> FAX 588-7948 <br /> <br />ONE AND TWO FAMILy DWELLING PERMIT APPLICATION <br /> Includes elecgrlea~ n~ehanlc~ pI~mbing f~ <br /> <br />FOR CITY USE ONLY <br />City Setbacks: <br /> <br />Left: ,~'s Right: ~ <br />S~: <br /> <br />l~lllog labels must he obtained at Marion County Building Inspection and must he placed a! tie job site prior to Iospeetion for plembing, electrical and meebaMeal <br /> <br />~rk. ConL~t Marion Connty for Instrneftous. <br />1. JOB DESCRIPTION <br /> <br /> ~ New Single Family Dwelling with Attached Gara$¢ <br /> ( ) NewsingleFamilyDv~llingwiihDe-tachcdGarag¢ <br /> <br /> ofWor <br /> Squa~ Footage: Besemont:,~l!~ ,st Floo~; ~ t 2nd Floor: <br /> <br />( ) New Duplex with Altach~l Garage <br />( ) NewDuplexwithl~,'tachcdGaragc <br /> <br />Other: Ga~g~: r~' 7~ # Stories: Units: <br />Dwdlin$ Height: ~/~r ~ ~: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Lot: Block: <br />U~: ()V ()~ [ Civ~Se~rSegin System~ <br /> <br />CONTRACTOR INFORMATION -- PLEASE INDICATE WHO lis DOING THE WORK <br /> <br />() <br /> <br />I am ~he PROPERTY OWNER and own, reside ia, ot will r~ide in tim ~leted stru~re and will be my own gan~al annlmelor. I undeesland flint I muSt ~gis~r <br />as a ~onstmetinn comra~w if the stmc~m ~ sold or offered for sale befo~ or upon completion. IfI h/re subanc~ta~to~ 1 will hire only subcontractors r~gis~ca~cI with <br />the Constmetian ConlxaOors Board, I f I change my mind and do h/r~ a ganeral conlracto~ who is regisawcd with lhe Conslructiou Comra~ B~ 1 ~1 <br />immedialdy nofif~ Mm'ion Coup' of the tame of thc contract, <br /> <br />I am abe AUTHORIZED R~PRESENTATIVE of the proPerty owner or the contractor. <br />Business Name (please print) <br /> <br />4, F~$ <br /> <br />Sheet City Zip Phone <br /> <br />I am a CONTRACTOR registg.~nwtih t~ State ~{Oreg~n. <br />BusinessNam~(pleaseprint): _/I/~.e--./,:. ~ r--.L/ Oa ~ <br /> <br /> Street Cily <br /> <br />Or-' q '7 2 '-t q't q z y'-z <br />Zip <br /> <br /> ALUATION (Se~ Valaatio~ ~:hca'~l, t~ d~tsff~n~ 0a~ valua6~ <br />~) <br /> Living~ S~F~ /~a x $64.66 = $ <br /> G~geSqu~F~ ~ x $16.27 = $ <br /> <br /> ~ <br /> ~ $0.090 ~ ~u~ ~ <br /> <br /> ~ <br /> Plan R~iew Fee <br /> <br /> <br />