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~ ~-,~ ,...MARION'COUNTY <br /> . lY/. INSPECTION <br /> ~,. .// II~l' ~ S~na~r ~iJ~ing ~225 <br />Appl. Recd,~ 220 High ~/,~-~nd Floor <br /> / , ~ k ,' .... C ' ~m ~on 97301 <br />By:.~_ .~ <br /> '"-I 588-5147 -- 588-5148 <br />ua[e: .~ ~- ~ ~l[~l~l~ I~f~ ' ........................ <br /> ¢.. - .... " <br />Type of Permit:~ .... Tax Lot No.:, <br /> <br />Bldr. & NO,~~~ ¢~=~e: ~' J~ Address: / <br /> <br />Permit No,: 00003 <br /> <br />By: Dottie <br /> <br />Date; 6/] 6/86 <br /> <br />_Twnshp,: Rge,: <br /> <br />Plans by: Phone: ..... Address; <br /> MapPage Z0ne' / ZoneChange "'~art..,.. ConS. USe Variance/Adj. FT/FD .J' Occupancy ] TypcofCon~t. <br /> Use of Sldg,: No. Bdrms. Mia Req, Front [' Sides Rear <br /> or Occ. Ld.: Setb~cl($', <br /> l <br /> <br />Lot No,: ,, BIk. No,: .... Sub, dy.: <br />Area of Bldg, 2nd Base- Total <br />Main Fir.: __Fir.: __merit: Area: <br /> <br />Roof Type: Truss/Stick: <br />Heating Wood <br />System: .Stove: <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 />Water <br />Supply: <br /> <br />Height: <br /> <br />Lot Size; __Corner?_ <br /> <br />Valuation: <br />13~dg. Permit <br />Fee; (+ 5%) <br /> <br />Elect. Fee: <br /> <br />Mech. <br /> <br />Plumb. Fee; <br />State <br />Su rcharge:¢;/o) <br /> <br />Plans Ghk, Fee: __ <br /> 3.84 fl eeff"~:hge <br />Septic <br /> Tank <br />Permit Fee: <br /> <br />I agree to build according to the submitted plans and specifications, the laws of the <br />State of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK <br />NOT COMMENCED WITHIN 150 DA YS. I further expressly warrant that I comply with <br />the provie/one of ORS 701.005 to 701,125 because: <br /> <br />( ) I em performing work on a property I own <br /> of occupy <br />( ) I am a registered builder OR ( ) the <br /> authorized 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 /> <br />BLDG. <br />RECEIPT NO,; <br />Driveway <br />Permit Fee: <br />Site Pran <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 ia true and correct to the best of my knowledge. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> PLEASE NOT~, Driveway and sidewalk inspection are required by Public Works: 588-5036 <br /> Other permits required by this dept.: Plumbing [3 Electrical [] Mechanical [] <br /> <br /> <br />