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Appl. Roe <br />By: __ <br /> <br /> MARION COUNTY <br /> E.T. Or ,..*..CT,O. <br /> Senator Building #228 <br /> 220 H~g~ St., N.E. 2nd Floor <br /> <br />Permit No.; <br />By:. <br /> <br />[~ate: MARION (~0UNTS~® P.M ....................... CODE-Aophone ...................... 8:00 A.M. DAte: <br /> <br />TypeofPerrnit:~..~)~'¢f~ O~:~ '~'(~!~)~~'- ~'~'-. TaXLotNo,: /~/ <br />Address: P.: ¢' <br /> <br />Bldr. & No,;. Phone: ...... ~ <br />Plans by: __ Phene: Address:. <br /> <br /> C~ e Part. i 0end. Use vaeance/Adj. Type of Const. <br />Use of eldg,; Front Sides Rear <br /> <br />Lot NO.: ...... B/k, NO.: .Sub. dy ' Lot Siz~'~ (;omar. <br />Area of Bldg. 2nd Base- Total <br />Main Fir.: Fir.: merit: - .&rea: Valuati0n:. <br />  ...~ Bldg. Permit <br />Roof Type: Trus$/S Height: Fee: (+ ~%) .. <br /> <br />System: /St er ly: Eject. Fee; <br />Septic Tank <br /> <br /> V <br />Exist, <br />System; -- s Plumb. Fee; <br /> State <br />VALIDATIONS; Surcharge: (4%) <br />Zoning: ~ hanicah <br />Date; .... <br /> Plans <br /> Chk. <br /> Fee: <br />Septic Tank: Plans: Septic Tank <br />Date: ..... Date: Permit Fee: __ <br /> <br />I agree to build according to the submitted plans and specificationa, 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 provisions of ORS 701.005 to 701.125 because: <br /> <br />I am per/ormin9 work on a property I own <br />or occupy <br />/ am a registered builder OR ( ) the <br />authorized representative o! a <br />registered builder <br /> <br />REMARKS:. <br /> <br />DEQ Surcharge: <br /> <br /> TOTAL FEE; <br /> BLDG. <br /> RECEIPT NO.; __ <br /> (~) The work w/il be performed Driveway <br /> by a registered builder Permit Fee: <br /> ( ) Other (please specify) Site Plan <br /> ~.~ ~ Review Fee: <br /> <br />Z/I/~-~"'-'-"~'~/'~ *~f~'Receipt No.: .... <br /> <br />I have read this application in its e~ty and certify that the stated information is true and correct to the best of my knowledge. <br /> <br />~v 7 85 Other p~ts req~red by this dept.: Plumbing ~ Electrical Mecham a <br /> <br /> <br />