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Appl,, Revd I.~3 I~'] ~ <br /> <br />Date:: <br /> <br /> MARMON COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St,, N,,E,, 2nd Floor <br /> Salem, Qregon 97301 <br />R.II_ WITHROW, BLDG, ADMINISTRATOR <br /> ~ 588-5147 - 588-6148 <br /> <br />Type of Permit;: ?~ddition Lo lqob~lc ;{ome <br /> <br />Owner;: <br /> <br />Bldr, & No Phone:: Address:: <br />_Plans bv:: Phone: Address. <br /> <br />Map Page Part o!% OOnd Use Variance ] <br />Useof Bldg :: ~ Min Req <br /> <br />.___Tax Lot No:; <br /> Sec, 2l <br /> <br />Twnshp, L~ Rge :l', <br /> <br />· ~ ~¢upancy Type of Corlst <br /> <br /> Front t Sides / Roar <br /> <br />Lot No:; __BIk. NO: Sub dy <br /> <br />Lot Size 1~,, :,ceos Corner? __ <br /> <br />Water Supply~,qe! I '1 Valuation;; __ <br />Sewage Site <br /> Evah: Permit Fee;; <br /> No,, <br />Area of 81dg; ~.~ x 2ti Stories::. ]' State Surcharge;; ,,~:~0 <br /> Roof <br />Basement;; :~1o Type- ~J~ i C!, Plans Chk,, Fee:: <br />Heating <br /> Septic Permit Fee;; <br /> <br />BTU:; ___ <br /> <br />Rcpt, No;; -~,/--G, ~ <br /> <br />I agree to b~i/d according to tile ~ubmi't1:ee~ plan~ and specifications the law~ of the State of OreEon and th~ Ordinances of Mar/on <br />County Permit expire~ if work not commehc~ w/~in 120 days, , ..~ f <br />SIGNATURE OF APPL CANT ~.'~~ f-~¢ ~/¥~' · ' <br /> <br /> REMARKS <br /> <br />PLEASE NOTE;; Driveway and sidewalk inspections are required by Public Works;; <br /> <br /> Other permits required by this dept: Plumbin§ [-] Electrical [] <br /> <br /> <br />