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~J Ib~El~lOF BI~J~ ILDI~G INSPECTION <br /> ~ Senator Building #225 <br />Appl~Rec~..___ ...Rec ' u Lt .... 220 High St., N.E. 2nd Floor <br /> <br /> MARION COUNTY 588-5147 -- 58e-5148 <br /> ~ , ';,'-','~t~ ' ~:DQ ~ .... CODE-A-Phone 8'00 <br />Date[ <br /> Rd ~ DING NS~bU~ IU~ ............................... <br /> r <br /> <br /> / ~ <br /> <br />Permit No.: <br /> <br />By: <br /> <br />Date: <br /> <br /> ,Tax Lot No ' <br />~Y,'~1/'7~Sec.: Twnshp.: ___Rge,; <br /> <br />SIdr, & No' Phone:_ Address: <br /> <br />Plans by: Phone; ...... Address: <br /> <br />Area of Bldg, 2nd Base- Total <br />Main Fir.: __ Fir,: ment; Area; <br /> <br />Roof Type:. Truss/Stick:_ __Height: ......... <br />Heating Wood Water <br />System: __Stove; Supply: <br />Septic Tank New <br />Site Eval.; .Instal.: <br />Exist. No. <br />System: _Gals,; <br /> <br />VALIDATIONS: <br />Zoning: Mechanical; <br />Date: .Date: <br />Septic Tank: Plans: <br />Date: Date: <br /> <br />Lot Size: Corner? <br /> <br />Valuation: <br /> <br />Bldg. Permit <br /> <br />Elect. Fee; <br /> <br />Math, Fee; <br /> <br />Plumb. Fee: <br />State <br />Surcharge:. (4%) <br /> <br />Plans Chk, Fee; <br />Septic Tank <br />Permit Fee: <br /> <br />DEQ Surcharge: <br /> <br />TOTAL FEE: <br />BLDG. <br /> <br />I agree to build according to the submitted plans and specifications, the laws of tile <br />State of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK <br />NO T COMMENCED WiTHIN 180 DA YS. I further expressly warrant that I comply with <br />the provisions of ORS 701.005 to 701.125 because: <br /> <br />( ) I am performing work on a property I own <br /> or occupy <br />( ) I am a regieterecl 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 />RECEIPT NO,: <br />Driveway <br />Permit Fee: <br />Site Plan <br />Review Fee: ........ <br />Public Works <br />Receipt No,: <br /> <br />REMARKS: <br /> <br />I have read this application in its entirety and certify that the stated information is true and correct to the best et my knowledge. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> PLEASE NOTE: Driveway and sidewalk inspection are required by Public Works: 588-5036 <br /> <br /> Other permits required by this dept.: Plumbing [] Electrical E1 Mechanical [] <br />REV 7-as <br /> <br /> <br />