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[U) ~-~ Lt~ t~ u "OEP~_[I~ BUILDING INSPECTION <br /> · t ~\ ~ ~- Sen~to~ Building ~225 <br />App[. Recd:: ~~ ~ ~ ~ ~'~ 2~0 High St., N.E. 2nd ~loor <br /> <br /> , , ~ ~-"" Salem, Ore,on 97301 <br />~Y'~ ~ --'~" C~N1~ 588-5147 588 5148 <br /> 7-/ .......................................... <br /> <br /> Permit No,: <br /> <br /> By:. <br /> <br />A,M, <br /> Date: <br /> <br />Sec.:T, .shp.: RGB.:_ <br /> <br />Bldr, & NO.:__ Phone: Address: <br /> <br />Plans by: Phone; ..... Address: , <br /> <br /> Map Page Zone Zone Change P~';t, Cond, Use J Variance/Adj. FT/FD <br /> <br />Use of Bldg.: [ NO, Bdrms.' Min Req. <br /> or ncc, Ld.: ~ Setbacks; <br /> <br />Occupancy <br /> <br /> I <br /> <br />Type of Cons:. <br /> <br />Area of Bldg. 2nd Base- tal <br />Main Fir,: _Fir,; ...... men::-- 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: b 7?, 'Corner? <br /> <br />Valuation: ,, <br />Bldg. Permit 40' 0 0 <br />Fee: (+ S%) <br /> <br />Elect, Fee: <br /> <br />Mech, Fee;__ <br /> <br />Plumb. Fee: <br />State <br />Surcharge; ~(?/0 ) <br /> <br />Plans Chk, Fee: <br />Septic Tank <br />Permit Fee: <br /> <br />I agree to build according to the submitted plans and apecifications, 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 provisions of ORS 701.005 to 701. 725 because: <br /> <br />( ) I am performing work on a property I Own <br /> or occupy <br />( ) I am a registered builder OR ( ) the <br /> authoo'zed representative of a <br /> registered builder <br /> <br />The work will be performed <br />by a registered builder <br />Other (please specify) <br /> <br />DEQ Surcharge: <br /> <br />TOTAL FEE: <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 />I have read this application in its entirety and certify that the stated information is true and correct to the beat of my knowledge. <br /> <br />SIGNATURE OF APPLICANT; _ ~ <br /> t~ n required by Public Works: 588-5036 <br /> · . PLEASE NOTE: Dr'K'eway and sidewalk inspec 'o are <br />MC t ~e Other permits required by this dept,: Plumbing [] Electrical [] Mechanical 0 <br />REV ?- $$ <br /> <br /> <br />