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Appl Recd,, <br /> <br /> MAR[ON COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building #225 <br /> 220 High St, NE, 2nd Floor Permit No:: <br /> Salem, Oregon 97301 <br /> 588-5147 -- 588-5148 By; <br /> <br />5::00 PM ............. CODE-A-Phone ......... 8::00 A,M,, <br /> Date <br /> <br />Type of Permit::_ __Tax Lot No::. <br />Address:: .10 Sec.:. _Twnshp <br /> <br /> / <br />Bldr & No i ~ ~ r <br /> Phone:~ Address <br /> <br />Rge,,' __ <br /> <br />Plans by .Phone;: <br /> <br />.._._..__Address <br /> <br />Lot No_ .~P B lk NO:: '-~ Sub dv '~J~ ~ <br />Ares of Bldg__fl 2nd Base- .. Total <br />Main Fir:: 3~. Fir,,:: i~,~ merit: ,,:,:,,, Area:: <br />Roof Type ~ ¢1 ~, Truss/Stick::~eig h,::~ <br />Heating Wood Water <br /> <br />SepdcSystem:: Tank~"~'~"~ * __St o ye:: New .Supply:: ~"~ <br />Site Eval .instal <br />Exist No,, <br />System .Gals, <br /> <br />VALIDATIONS <br />Zoning Mechanical:: <br />Date:: ~._Date <br />Septic Tank Plans:: ,-~ ~ <br /> <br />I agree to build according to tho submitted nd specification,, the laws of the <br />State of Oregon and the Ordinances of Marion County, PERMIT EXPIRES IF WORK <br />NOT COMMENCED WITHIN 180 DA YS, I further expressly warrant that I COmply with <br />the prows~ons 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 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 />REMARKS:: <br /> <br />Lot Slze::~f~"~ <br /> Va,.atio.__J,-qt <br /> Bldg. Permit <br /> Fee:: (+ 5%) <br /> <br />Elect Fee:; <br /> <br />Mech, Fee <br /> <br />Plumb Fee:: <br />State <br />Surcharge;: <br /> <br />TOTAL FEE::.~__~,~'5. 2 5- <br />BLDG,, <br />RECEIPT NO <br />Driveway <br />Permit Fee _ <br />Site Plan <br />Review Fee <br />Public Works <br />Receipt No..:: <br /> <br />I have read this application in its entirety and cer~ed inforrn~~st of my know/edge. <br /> <br />SIGNATURE OF APPLICANT ~ ~~'""- <br /> PLEASE NOTE' Drweway and sidewalk inspection are required by Public Works:; 588-5036 <br />MC 15-6 <br />~v 7- $5 Other permits required by this dept :: Plumbing [] Electrical E] Mechanical [] <br /> <br /> <br />