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MARION COUNTY
<br /> DEPT. OF BUILDING INSPECTION C~ /5/ ~ 0//~3/^
<br /> Senator Building #225
<br />Appl. Recd,; 220 High St., N,E. 2nd Floor ~ermit NO.: 85-1165
<br /> Ch~±s Salem, Oregon 9730~ / ~ ~
<br />By: 588-5147 ~ 588-5148 By; Pa~
<br /> 5:00 P.M ....................... CODE-A-Phone ...................... 8:00 A.M.
<br />
<br />Date: 12-2-85 Date: 12-17-85
<br />
<br />Type of Permit' C.~g,h Addition Office,Recep.&Waitinq Rm~ax Lot No.:
<br />
<br /> 9168 Silver Falls Highway SE Aum$o Sec.: 13 Twnshp.: x~ B,,~ge,: 2W
<br />Address:
<br /> 5~. ~;~y's 9~ish /Sha~ ~a~h~ the=les TaaEfe
<br />Owner', ~Phone:~ddress; 97325 same as abo~,
<br />
<br />Bldr, & N~¢am Zieb~t Phone;,, 363-8202 ,, Address; 7750 A~vllle H~ SI 97301
<br />
<br />Plans by: Phone; Address;
<br /> Map Page/~d~,' J e,rt. ;~ Variance/Adj. J ,T/FB , ¢¢ Occupancy
<br /> No. Bdr~s. ~ MI~ Req. Front ' Sides , Rear
<br />
<br />Lot NO,: BIk, NO,:
<br />Area of Bldg. 2nd Base-
<br />Main Fir,: 1003 Fir.: _Tent; .............
<br />
<br />Roof Type: -T~/.".~~ Truss/Stick: - r~%~
<br />Heating /~ /~,. '--¢-~-,,.~-. Wood Water
<br />S atem:,-', __ ,supp,y:
<br />Septic Tank New
<br />Site Eval,: .Instal.;
<br />Exist, NO.
<br />System; .Gals.:
<br />
<br />~ub. dy.: Lot Size; acres Corner?
<br /> Total
<br /> Are~: :1003 Con'b:'- Valuation: 27~4,00.00
<br /> Bldg. Permit 184.00
<br /> 9.20
<br /> Height: -~-,.~- ' Fee: (+ 5%)
<br />
<br />VALIDATIONS:
<br />Zoning: 2. '
<br />
<br />Septic Tank:
<br />
<br />nq
<br />
<br />Well
<br />
<br /> Mechanfcah
<br /> Date:
<br />
<br />Existing ...... Date: /':~ -/~' ~'~
<br />
<br />Elect. Fee: ................
<br />
<br />Mech. Fee:
<br />
<br />Plumb, Fee:
<br />State
<br />Surcharge: (4%) 7.36
<br />
<br />Plans Chk, Fee: 119.60
<br />Septic Tank
<br />Permit Fee:
<br />
<br />S6. q -60
<br />3 .sq
<br /> too.
<br />
<br /> County. PERMIT EXPIRES IF WORK
<br />~her expressly warrant that I comply with
<br />
<br />wn
<br />
<br />) The work will be performed
<br /> by a regiatered builder
<br />) Other (please specify)
<br />
<br />DEQ Surcharge:
<br />
<br />TOTAL FEE:
<br />BLDG,
<br />RECEIPT NO,:
<br />Driveway
<br />Permit Fee: w.
<br />Site Plan
<br />Review Fee; ......
<br />Public Works
<br />Receipt NO.;
<br />
<br />320.16
<br />
<br />,, .... ,~,.~,~ .,,, ;t ce~r~y that the etated information is t£ue and correct to the best of my know/edge.
<br />
<br /> SIGNATURE OF APPLICANT: , ~' ~ ~' -~,
<br /> PLEASE NOTE; Driveway and sidewalk insp~tion are required by Public Works:
<br />
<br /> Other permits required by this dept,: Plumbing ~ Electrical Q Mechanical
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