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· ~ ~ MARION COUNTY <br /> ~ DEPT. OF BUILDING INSPECTION <br /> ~ senator Building #225 <br /> <br /> I~'~ ~,~t . '3 ' 220 High St,, ~E,, 2,d Floor <br /> A~p(~ecd * 7 ~ Salem, Oregon 97301 <br />8y <br /> ,,.V,' *~, 588-5147 -- 588-5148 <br />Date 0~ 5::00 PM CODE-A-Phone ............. 8::00 A,M, <br /> <br />~3'Lr~ ~' '~ ' <br />T~pe of Permit Tax Lot No,:: <br /> <br />Permit No:: <br /> <br />By:: <br /> <br />Date:: <br /> <br />Sec,:: __Twnshp :: Rge :: ,. <br /> <br />Bldr & No .Phone;: ,Address:: <br /> <br />Ptans by' .Phone:: Address <br /> <br /> Use of Bldg [ NO edrm$ [ Mtn Req <br /> I <br /> or O¢o Ld I Setbacks <br /> <br />Front [ Sides <br /> <br />Rear <br /> <br />LotNo /2 Blk No . ///~.__Sub dy.:: <br />Area of Bldg 2nd Base- <br />Main Fir .Fir merit; <br /> <br />Roof Type Truss/Stick <br />Heating Wood Water <br />System:: _Stove;: Supply;: <br />Septic Tank New <br />S~te Eval :: Instal:: <br />Exist No, <br />System Gals,,:; <br /> <br />VALIDATIONS <br /> <br /> Lot Size E~?¢y ~~Corner? <br />Total /~ '~ / ~ ~'~. <br />Area:: ;~¢0 ~oJ¢ Valuation <br /> Bldg,, Permit <br />Height:: Fee (+ 5%) <br /> <br />Elect, Fee <br /> <br />Mech Fee <br /> <br />Plumb Fee:: <br />State <br />S u rc ha r g e:: ..,(__4_~0 ) <br /> <br />Zoning Mechanical" <br />Date Date:: __ <br />Septic Tank' Plans <br /> <br />I agree to build according to the submitted pC'J~ansand specifications, the laws of the <br />State Of Oregon and the Ordinances of Marion County, PERMIT EXPIRES IF WORK <br />NOT COMMENCED WITHIN 180 DA YS. I further expreasly warrant that I comply with <br />the provisions of ORS 701 005 to 701,125 because;' <br /> <br />( ~am performing work on a property I own ( Or Occupy <br />( ) I am a registered builder OR ( ) the ( <br /> author/zed representative of a <br /> registered buffder <br /> <br />) The work will be performed <br /> by a registered builder <br />) Other (please specify) <br /> <br />BLDG <br />RECEIPT NO <br />Driveway <br />Permit Fee:: <br />Site Plan <br />Review Fee <br />Public Works <br />Receipt No <br /> <br />REMARKS <br /> <br />! have reed this application in its entirety and certify that the atated information is true and correct to the best of my knowledge <br /> <br /> PLEASE NOTE Driveway and sidewalk inspection are required by Public Works, 588-5036 <br />MC 15-6 <br /> Other permits required by this dept,;: Plumbing [] Electrical [] Mechanical [] <br /> <br /> <br />