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.................................... ] MARION COUNIY BUILDING INSPECTION ............................................................ <br /> I~R CIIY l~S~ ~_' COMMUNITY DEVELOPMENT CENTER FOR CITY USE ONLY <br /> R~..eivcd By: ~../t~.~.,~. ~4.__~_..._x t_ ~ ~ 3150 Lancaster Dr. NE- Suite C <br /> City <br /> Setbacks: <br /> Zoning By: ,dff./~.,4r'''~ City:~i~-*~v- Salem, Oregon 97305 <br /> P,J~i~t #: ' ' - Amount: $ ~ L~fi: ~.~ Right: ~'- <br /> ~ 8:00 ~n -4:30 pm <br />.................................... 2 2¢ hL Inspection Line ~ ~3y~a, .~ Spacink <br /> FXX ............................................................ <br /> ONE AND TWO FAMILY DWELLING PERMIT A~I~]~['~{~/~) <br /> <br />~rZ Co=~ct Mmon Coun~ br instrue~n~ ~d. <br />1. JOB DESC~TION ~,.m~RION ~, .. <br /> <br />(~) N~v Single Family Dwelling with AUaehed Garage <br /> Now single Family Dwclliflg with De-tached Garage <br /> <br />2. LOCATION OF INSTALLATION <br /> <br /> ) New Duplex with DetaEIle~ fi~/~/ <br />Occupancy: ~r~ C~qst. Typa: <br /> <br />U~its: <br /> <br /> ParcelS~: ~SF () AC UGB: ~Y () N <br /> <br />S. CO~CXOR ~FO~ATION ~ PLEASE ~BICATE WHO 1S ~G T~ WO~ <br /> <br /> ~iately noti~ M~ C~n~ of~c nan~ of thc ~n~a~. <br /> ( ) I am ~c AUTHORIZED ~PR~ENTAT~ of the pro~r~ o~cr or ~e contractor. <br /> <br /> / <br /> Icity Sewer <br /> Septic System <br /> <br />Wate~Supply: ( ) ~vateWell ( ) C~u~WoII <br /> <br />Mailing Address: <br /> <br />() <br /> <br /> Slrect <br /> <br />I am a CONTRACTOR registered with the State of O~gon. <br />Business Name (please print): <br /> <br />Mailing Add.mss: <br /> <br />City Zip <br /> <br />Phone <br /> <br /> Street City <br />4. FEES <br /> <br /> VALUATION (See Valuation Schedule to determine thc valuation based on square <br /> ~otage) <br /> <br /> LivingA~a SquareFeeh~' x $64.66 = $ ~_1~, ~O <br /> Gamge Square Feet ~..'~' x $16.27 = $ ~&~.'Tg' <br /> <br /> A. 1. Permit Fee: <br /> g/O · = $ /3c/O,r2r <br /> Building ~ $0.185 per square foot <br /> Electrical ~ $0.090 par square foot <br /> M~hanical @ $0.040 per sqaaxe foot <br /> Plumbing ~ $0.090 per square foot <br /> <br /> 2. Plan Review Fee <br /> ,OrossSqua~'eF~t~ti~LL~ x *0.120/sq. Ft=$ 3q~7, ~ <br /> <br />Zip Phone Fax <br /> <br />(1) Permit Fe~ (A-1) $/~$7, ?f <br />(2) State Surcharge ( lbS-%,.v.~.~ ~,071ttl'i <br />(3) ~ R~w F~ (A-2) $ <br />(4) ~i~ ~ ~i~/~~ ~ ~ ~ ~ ~ ~ <br /> m~i~m~f~r. Igdl~ll ~/I~11 II <br />(4) ~ng Su~har~, ifappli~ble (J~ ~ ~ ~ ~ ~ j J ~ ] <br /> <br />(6) ~n F~. $50.~ <br />(7) In.ohs ~de ouBi~ or.mi <br /> ~si~ h~rs, $50~, ~m ~o <br />(8) In~ ~r win~ no ~ is ~*~* I~* TM ~1 TM ~ ~ <br /> <br />( 11 ) A~itio~l S~s of Plan~ ~ ~ $ <br /> TOT~ $~. '~ <br /> <br />I hereby certify that the above information is correct. Pcmgts~arc non-tran~e~rablc and expire if work is not started within 180 days ofissuanoe or if wonk is suspanded for 180 days. <br /> Name of Applicant [~l~sc P~pt]: ~:~'~'d lift' <br /> Mailing Address: ,/,s.~. ~dX. ~'Z-~'O / O..L.,~E.~E~/,/~. ~ <br />Signature of Applicant;(~/JJe~.~/~'~ · ,~ [ ' Date: ~f/~'~ ,~ ~ ~., MC I~o ~ <br /> <br /> <br />