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Appl. Recd~ <br /> <br />Date: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High Bt., N.E, 2nd Ftoor <br /> Salem. Oregon 97301 <br /> <br /> 588.5147 - 588-5148 <br />5:00 P.M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A.M. <br /> <br />Type of Permit: <br /> <br />~-=' ';-~ , ,,,,Tax Lot No: <br /> <br /> Sec, ~ Twnshp. Roe. <br />Address: <br /> <br />~ ":~: "' = Phone: Address: .' ~ ...... <br /> <br />Plans by: Phone: Address: <br /> Me~3 Page { 7°ne I Z°ne Chg' ~l~-I ;irt'~J¢~/." L ~:~ . Cond'U~ { Variance { FireZ°ne I Occupancy ITyPe °f COnst' <br />U. of BI*.: No 'drm", ;~ MEn R,. ;~ , Sides ~ ~ Rear ~ <br /> <br />Lot No.: Slk. No ' Sub dv, <br />Area of Bldg. 2nd Base- Total <br />Main Fir,: FIr,~ ,,__ ment: Area: Z/-' ,~2 '~ Valuation: <br /> Bldg. Permit <br />Roof Type: .. Truss / Stick~ .__ Fee; VJ~/~ __, <br />Heating Wood Water <br />System~,. ~ $tove~ Supply: Elect, Fee- <br />Septic Tank New ~L ~ :'~(~'~ <br />Site EvO{;. [nSt~l,: Math, Fee: <br />Exist. No. <br />5ystem~ Gals.: ,. Plumb, Fee: <br /> State <br />VALIDATIONS: $urcharge:.~ <br /> <br />Septi~ ~'~; ~ Plans: Septic Tank <br />Date: ~ ~ Date: Permit Fee- ' <br /> .... <br /> <br />Lot S~ze~Corner,. <br /> <br />I agree to build according to the submitted plans and specifications, the lows of the State <br />of Oregon and the Ordinances of Marion County, Permit expires if work not commenced <br />within 180 days. I further expressly warrant that I comply with the provisions of ORS TOTAL FEE¢ <br />701.005 to 701. 125 because: <br />( } I am performing work on o property I own or occupy RECEIPT NO.t <br /> ) I am a registered builder OR ( ) the authorized <br /> representative of a registered builder <br /> <br />DEQ Surcharge: __ <br /> <br />The work will be performed by a registered builder <br />Other (please specify) <br /> <br />REMARKS: <br /> <br />I have reed th~ application in its entirety end certify that the stated information i~ ~ect to the best of my know/edge, <br />SIGNATURE OF APPLICANT:~~~~ , <br /> PLEASE NOTIr~ections are required by Public Works; 588-5036 <br /> Other permits required by this dept: Plumbing ~1 Electrical ~] <br /> <br /> <br />