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~'" I I } I Senator Building #225 <br />Appl Recd b~ 220 High St, N E, 2nd Floor <br /> LI~ <br />By MAY 5 1986 Salem: Oregon 97301 <br /> ~ 588-5147 -- 588-5148 By:: <br /> <br /> ~ ~ ~/ ~ 0N ~,M CODE~A-Phone 8;;00 A M <br /> <br /> Type of Permit ~J~ ~ ~(/~ ~Tax Lot No <br /> <br /> Owner::-~r~g <br /> Bldr & NO <br /> <br />Permit NO 476 <br /> <br />Dottle <br /> <br />9/16/86 <br /> <br />Rge :: ~ <br /> <br />Plans by Phone Addre~a <br /> i[~)P~e i Zone [ ZoneChange I ~art I Cond Use variance~Adj [ FT/FD Occupancy ,, Type of Const <br /> <br /> Use NO Bdrms Mln Req Front Sides Rear <br /> et eldg ~ or O0c Ld 9~ Setbaoks [ <br /> <br />LotNo:: /c~ BIk NO, // .Sub dY,;: YaF ..... Lot Size __Corno,? /JO <br />Area of Bldg 2nd Base- Total <br /> Area Valuation <br /> Bldg Permit <br /> <br />Main Fir ........... Fir:: .... merit <br /> <br />Roof Type Truss/Stick;: <br />Heating Wood <br />System .Stove <br />Septic Tank New <br />Site Brai _Instal <br />Exist NO <br /> <br />System ............................. Gals:: <br /> <br /> ......... Height: <br />Water I%" ~,~ <br />zupply;; <br /> <br />VALIDATIONS:: <br />Zoning Mechanical, <br />Date __ .Date <br /> <br />Septic Tank. 0 .. <br />Date ,-4¢-- <br /> <br />Plans <br />Date .... <br /> <br />Fee:: (+ 5%) <br />Elect Fee:: <br />Mech Fee:: <br /> <br />Plumb,, Fee <br />State <br />Surcharge:: (4%) <br /> <br />Plans Chk Fee <br />Septic Tank <br />Permit Fee <br /> <br />do, oO <br /> <br />I agree to build according to the submitted plane and specifications, the laws of the <br />State of Oregon and the Ordinances of Marion County, PERMIT EXPIRES IF WORK <br />NO T COMMENCED WI THIN 180 DA YS I further expressly warrant that i comply with <br />the prowsions of ORS 701.005 to 701,125 because' <br /> <br />( ) I am performing work on a property I own <br /> or occupy <br />( ) Iern a regietered builder OR ( ) the <br /> authorized representative of a <br /> registered builder <br /> <br />( ) The work will be performed <br /> by e registered builder <br />( ) Other (please specify) <br /> <br />DEQ Surcharge <br /> <br />TOTAL FEE <br />BLOG <br />RECEIPT NO <br />Driveway <br />Permit Fee:: <br />S~te Plan <br />Review Fee <br />Public Works <br />Receipt No <br /> <br />6080 <br /> <br />REMARKS <br /> <br /> have read this application in its entirety and certify that the stated information is true and correct to the best of my knowledge <br /> <br />SIGNATURE OF APPLICANT;: L ~'"~' 'Z~' ~' ¢~¢'~--~.~C <br /> PLEASE NOTE Driveway and sidewalk inspection are required by Pubhc Works 588-5036 <br /> <br /> Other permits required by this dept Plumbing [] Electrical [] Mechanical E] <br /> <br /> <br />