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MA.ION COUNTY <br /> Appl. R'cvd. DEPT. OF BUILDING INSPECTION Permit Number <br /> ~. 3180 Center St,, N.E. <br /> Salem, Oregon 97301 By: L~¢-~' <br />By: R.H. WITHROW, BLDG. ADMINISTRATOR <br /> <br /> cate: <br /> <br />Bldg. Permit: ....... Location Permit: <br /> <br />Address; ~t. ~ ['lox ~000 City:, <br /> <br />Owner; N.[~larioo School Dis.tric~5. ~ 5G04 Address: A~ura,... <br /> <br />Bldr,&No.: Sal:em ~oorirlq Phone: 393 2702 , Address: <br />P~n~ by: ~hone: Address: .... <br /> <br />Map Page <br /> <br />I2~one "I Zone Chg, Part. Cond. Use Vatlance Fire Zone OccupenPy Type of Const, <br /> <br /> M~n Req, Fro~t Sides Rear <br />E, le ent~ry School Setbacks: <br /> <br /> Sewage Fees, <br />Lot No: BIk, No:, Water Supply: . Disposal: ..... Study? <br /> <br />Sub dy. Vhluatlon: $ l "? s, 4 2 3 ·/. ~_ <br /> <br />Size of Lot:. Corner?__ Permit Fee:, <br /> <br />84.00 <br /> <br />Area of B~dg; <br /> <br />Plans Chk. Fee; <br /> <br />NO- of Stories: Ul'le $ Lor y State Surcharge: 2 , 52 <br /> <br />~asement; <br /> <br />Septic Permit Fee: <br /> <br />TvPeOf Roof: Hot-build wp Total Fees: ~6. !'~2 <br /> Rept, NO. 059~ <br /> <br />SIGNATURE OF APPLICANT: /~__. . .. , O /I}~~O~/, )-- , <br />VALIDATIONS: / / ¢ t ~ <br />ZONING SEPTIC TANK PLANS 2~ , //, <br /> <br /> REMARKS <br />existing roo'?iI~g. [~epair any dry rot. <br /> <br />bulld-u¢ tour'. <br /> <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works: <br /> Other permits required by this dept; Plumbing [] <br /> <br />588-5036 <br /> <br /> <br />