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P~ON <br /> <br />ByP CH :F. YL <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 226 <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 588-53?3 ........... 8;00 A.M. <br /> <br />Permit No. ~ <br /> <br />Date: <br /> <br />Type of Permit; .Tax Lot <br />Address: Sec, Twoshp, RUe <br />DOUGL,;,,5 ~:. N~CY COX <br /> <br /> 2.66 <br />Lot NO: BIk, No: ~ Sub dv, Lot Size Corner? <br /> <br />Water Supply: Valuation: ~ <br /> <br />Sewage Site 81-1176 35.00 <br />Disposal; __ Eval: Permit Fee: <br /> 14 x 70 No. 1./z_O <br />Area of Bldg: Stories:.,, State Surcharge: <br /> Roof <br />easement: Type; Plans Chk, Fee: <br />Heating 50. O0 <br />System: <br /> <br />BTU: ...... Total Fees: 91.40 <br /> Rcpt. No; <br /> <br /> I <br />/ agree to build ~cordi~ to the subm/tt~ plans and spec/f/caWons, ~e la~ of the S~ate of Or. on and the Or/dnances of Mario~ <br />County, Permit expires if work not commenc~ w/thin 120 days. I furhter expreas/y warrant that I comply with rh~ provisions of ORS <br />701.~ ea 701.125 because: <br /> <br />( ) lamar~/steredbui/d~or( ) theauthoriz~repre~n~a~/veofar~ister~builder <br />( J The ~rk wi//bepe~orm~byar~is~r~bugder <br />( ) I am performing work on a proper~y I own or occupy <br /> <br />I bare read this apptkadon in its ~tirety and certify that the stated, information is true and correct to the best of my know/edge. <br /> <br />SIGNATURE OF APPLICANT. ~ _~lJ <br /> PLEASE NoTE:'Driveway and siOewalk~spection, ~,e ~u[red bye036 <br /> Other permits required by this degz: Plumbing ~ctrlcal <br /> <br /> <br />