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Appt, Recd.: <br />By; <br /> <br />Date: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building #225 <br /> 220 High St,, N.E. 2nd Floor Permit No,:_ <br /> Salem, Oregon 97801 <br /> 58~ m 5B8-5148 By:. <br /> <br />5:00 P.M ....................... CUBE-A-Phone ...................... 8;00 A.M. <br /> Date: <br /> <br />Type of Permit: J~J&-t'~l k.)~- ~r~"'[' ~.~.. <br />Address: / ~ ~ ~ ~ ~ ~ <br /> <br />(_.~rule.-r <br /> <br />Phone: <br /> <br />Bldr, & No,: <br /> <br />Phone: <br /> <br />Plans by: <br /> <br />~ ~, Tax Lot No,~ <br /> <br />Sec.; Twnshp.: <br />Address; <br /> <br />..Address: __ <br /> <br />,, Phone:__ ~Address: <br /> <br />Use of B~dg.: ~ <br /> <br />Lot No.:_ ~ BIk. NO.: <br /> <br />part. J o~nd.U~ J van~nce/^sl, FT/¢O Occupancy <br /> <br /> or Ccc. Ld.: ~ Setbacks: <br /> Lot Size:~¢~/ Corner? <br /> <br />Rest <br /> <br />Area of Bldg. 2nd <br />Main Fir.; .Fir' <br /> <br />Base- Total <br />ment;., Area: <br /> <br />Roof Type:__, Truss/Stick: <br />Heating WOOd <br /> <br />Septic Tank . New <br />Site Eval,: .instal.: <br />Exist. No,. ~ <br />Systemt __ ~J ~ .... Ga,is.: <br /> <br />VALIDATIONS: <br />Zoning: Mechanical: <br />Date: Date: <br />Septic Tank: Plans: <br />Date: Date; <br /> <br /> Height:. <br />Water <br />Supply: _ ~[z. <br /> <br />Valuation: <br />Bldg. Permit <br />Fee: (+ 5%) <br /> <br />Elect. Fee: <br /> <br />Mech, Fee: ..... <br /> <br />Plumb. Fee: <br />State <br />Surcharge: <br /> <br />Plans Chk. Fee: <br />Septic 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 />NO T COMMENCED WI THIN 180 DA YS. I f~rther expressly warrant that I comply with <br />the provisions of ORS 701,005 to 701.125 because: <br /> <br />( ) I sm performing work On a property I own <br /> or occupy <br />( ) I ~m 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 />DEC Surcharge: <br /> <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 />REMARKS: <br /> <br />I have read this application in its entlr~e.~.~n?, certify that the stated information ia true and correct to the best of my knowledge. <br /> <br /> - PLEASE NO ubllc Works: 588-5036 <br />~c lS-S Other permits required by this dept.: Plumbing E] Electrical [~ Mechanical [] <br />RE:V 7-8S <br /> <br /> <br />