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I ' '~ CO3AMUN1TY DEVELOPMENT CENTER i FOR CITY USE ONLY <br />~ FOR CITY USE ONLY <br />I Received By:. Date: ' ~¥ ~ ~ 19c~lSOLancast~rDr'NE'SuiteC i City Setbacks: <br />I Zoning By: .City: ~ O,~ Salem, Oregon 97305 <br />~ ' · nt : Front' Rear' <br /> Rec~lptg: Amou :$ ~.L~ 800am 4'30 : ' --- - ~'- <br /> - -z_--L ~1~ 00[~4~r. : - . pm . : Lett: __ _ Right: <br /> ............... .......... --~nr~7.'''~ Inspection Line 3734427 Special: <br />L <br /> ' ' 111['[~[~8 J~[8~ION FAX 588-7948 ~ ................... :--~----~ ...................... <br /> ONE AND TWO FAMILY DWELLING-PERMIT APPLICATION <br /> Includes electrical, mechanlea~ plumbing.fees <br /> <br /> Dwi]ting ]abth taus; bt obtained at Marion Connty BuildinR lnspet~ion and mast bt placed at the job site prior to inspection for plumbing, electrical and mechanical <br /> work. Contact Marion County for instructions. . . . <br /> I. JOB DESCRIPTION <br /> ~ New Single Family Dwelling with Attached Garage ( ) New Duplex w0h Attached Garage <br /> New single Family Dwelling with De-tached Garage , - New Duplex with Detached Garage <br /> <br />-Description of Work: ~,e~ <br />Squar~ Footage. Ba~t 1 st Floor 2nd Floor: <br />Number of Bedroo~3s: '~ Existing: lh'oposed: <br /> <br />Occupancy Coast. Type: <br /> <br />Other: Garage # Stories: <br />Dwelling Height Garage Height: <br /> <br />Units: <br /> <br />2. LOCATION OF INSTALLATION <br /> <br />Parcel Ow~,: ~'~2 ~'//~gJO~./~'~' I MidlingAddre~s/o~'/t~/ /~t..~tOoetl~lO ci~o'm.~o';/OZiP <~75Z ~" <br />Subdivision: Lot: Block: <br /> <br /> 1 <br />Map: Zone: ! Part, Size: d ~ SF 0~I AC <br /> <br />Property Locater: Parcel : <br /> <br />Water Supply: (~ Private Well <br /> <br /> tcity S~v~r/l~O <br /> Septic Systam '-~/~-~ <br /> <br />ConmmthtyWell [ )City <br /> <br />3. CONTRACTOR INFORMATION -~ PLEASE ]iNDICATE WHO lS DOING THE WORK <br /> <br /> ( ) I am the PROPERTY'OWNER and own. reside in. or will reside in the comoleted structure and will be my own general contractor. I understand that I must register <br /> as a constmcoon contractor if the structure is sold or offered for sale before or upon completion. Ifl hire subcontractors. I will him only subcontractors registe~l with <br /> the Construction Contcacto*s Board If I change m3 mind and do hire a geaccal contractor who ~s registered with the Construction Contractors Board, I will <br /> immediately notify Marion County of the name of the contractor <br /> <br /> ( I I am the AUTHORIZED REPRESENTATIVE of the property 0v~er or the contractor. <br /> Business Name (please prmu <br /> <br />Mailing Address: <br /> Street City Zip Phone <br /> <br />[ am a CONTRACTOR registered with the State of Oregon. <br />Business Name (please print): <br /> <br />Mailing Address: <br /> <br />Registration # <br /> <br />&FEES <br /> <br />Street City Zip Phone Fax <br /> <br />VALUATION/See Valuation Schedule to determine the valuation based on square <br />footage) <br /> <br /> Living Area Square Feet x $64.66 - <br /> Garage Square Feet x $16.27 = $ <br /> <br />A. 1. Permit Fee: <br /> Gross Square Feet x $0.4050 = $ <br /> <br /> Building ~ $0.185 per square fool <br /> Electrical ~ $0.090 per square foot <br /> Mechanical ~ $0.040 per square foot <br /> Plumbing ~ $0.090 per square foot <br /> <br /> 2. Plan Review Fee <br /> Grc~sSquamFeet x $0.120/sq Ft=$ <br /> <br />TOTAL $ <br /> <br /> <br />