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Appl. Recd' <br />By:_ Do'ct'ce <br />Date: 10/10/85 <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Buildicg #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-Phone ...................... 8:00 A,M. <br /> <br />Permit No.; 85-Z02~ <br /> <br />By: P~ttz] . <br />Bate: 10-17-85 <br /> <br />Type of Permit:, B.e~oof <br /> <br />_Tax Lot NO.: ..... <br /> <br />Address: <br /> <br />20167 Grim Road NE <br /> <br />Owner: ~orth Marion ~[tgh School <br /> <br />Bldr. & No.:.L,e,igh~ a Roof Service <br /> <br />Plans by: <br /> <br />Sec,: ...... Twnshp,: Rge,: ___ <br /> <br />....... Phone: Address; <br /> 364-1938 Salem ¢~ <br /> Phone: 472-0031____Address: 755 A~pine Avenue <br /> -~~ -- "~--~ PO BoX 14 McMinnvtlle 97128 <br /> Phone: ..... Address; <br /> <br />Lot NO,: BIk. No,; Sub. dv.: <br />Area of Bldg. 2nd Base- Total <br />Main Fir.: Fir,; ment: Area: <br /> <br />Roof Type; built up .., <br />Heating Wood <br />System: _ Stove: __ <br />Septic Tank <br />Site Eval,; <br />Exist. <br />System; <br /> <br />Truss/Stick:~eight:. <br /> Water <br /> _Supply: <br /> New <br /> _Instal.: <br /> No, <br /> .Gals.: <br /> <br />VALIDATIONS: <br />Zoning: Mechanical: <br />Date: ,Date: <br />Septic Tank; <br />Date: __ <br /> <br />I agree to build according to the submitted plans and specification& the laws of the <br />State of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK <br />NO T COMMENCED WI THIN 180 DA YS. I further expressly warrant that I comply with <br />the provlalons 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 regl.ttered 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 (pleaae specify) <br /> <br />REMARKS:_ <br /> <br /> ...... <br /> <br />Lot Size: Corner?. <br /> <br />Valuation: 30,000.__ <br />Bldg, Permit 193.00 <br />Fee: (+ 5%) 9.65 <br /> <br />Elect. Fee: <br /> <br />Mech. Fee:_ <br /> <br />Plumb. Fee: <br />State <br />Surcharge:_/*%'? / 7.72 <br /> <br />Plans Chk. Fee: 125.45 <br />Septic Tank <br />Permit Fee: <br /> <br />DEQ Surcharge: <br /> <br /> 335.82 <br />TOTAL FEE: <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 entire/P~and certifj/~the stated information is true a~Zf~orrec&to the beat of my knowledge, <br />SIGNATURE OF APPLICANT: ~ /)~ ////~(~ ...~'/~'~,,, <br /> PLEASE NOTE: Drivewa~nd sidewalk inspection are required by Public Works: 588-5036 <br /> <br /> <br />