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Appl, Revd; <br /> <br />By: ~-:::;~i. <br /> <br />Date: ?-~- .-' <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDtNG INSPECTION <br /> Senator Building # 225 <br /> 220 High St,, N,E, 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588-5148 <br />5:00 P~M,- ........... CODE-A-Phane 58S.5373 ........... 8:00 A.M. <br /> <br />Permit No. ~ -/ 7 7 <br />By: <br /> <br />Type of Permit: ....... [ ...... <br />Address: _,. 7, ~ ..... ~J-i ;'-r <br />Owner; <br /> <br />Phone:, ~'~--;i~+~ Address: :::,:;~c.,, <br /> <br />Bldr. & No.; ............ Phone: . Address: <br /> <br />Plans by; Phone: Address: <br />~)'~Map Page ~' -~-~ ~on~ ZoneChg,, '"'~ar t. ,, Cond, U~ [ varian~ Fire Zone Occupancy I Type of Con~, <br /> <br /> U~ of ~ldg,: No Bdrm~, [Uin R~. Fro t <br /> or o~, ~: L Setbacks; <br /> <br /> LotNo; $1k. No:, Sub dv. Lot SiZ~ ~':';) :~ }Co,er? <br /> Wamr Supply: Valuation: ,, $ <br /> <br /> Sewage Site <br /> Eval: Permit Fee: <br /> Disposal: .... i~' <br /> Area of Bldg; ;~:' ]~ ~0 Stories: [ State Surcharge: <br /> <br /> Basement: ~- ' ~'" ~ ype: Plans Chk. Fee; <br /> Heating <br /> System: Septic Permit Fee: <br /> <br /> BTU: ....... Total Fees; <br /> Rcpt. No; <br /> <br />VALIDATIONS: <br />ZONING /~ ~~ ' SEPTICTANK PLANS ~ <br /> u'- ,g l o..: Date: ,~'...~" fi/7-'~ <br /> / <br />I agree to build according to the submitted plans and spec/f/cations, the laws of the State of Oregon and the Orldnances of Marion <br />County, Permit expires ff work not commenced within 120 days, I furhter expressly warrant that I comply with the provis/~ns of OR~ <br />701.005 to 701.125 because: <br />( ) lamereg/steredbu//deror( ) dTeauthorizedrepresentativeofaregisteredbugder <br />( ) The work w/il be performed by a registered builder <br />( ) / am performing work on a propert~ I own or occupy <br /> <br />I have read this application in /ts entirety and certify that the stated information is true and correct to the best of my know/edge. <br />SIGNATU RE OF APPLICANT~~/~ ~--~~. <br /> PLEASE NOT'~: Ddweway and sidewalk inspections are required by Publi~;/orks: 588-5036 <br /> I Other permits required by this dept; Plumbing [] Electrical [] <br /> <br /> <br />