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.;,~ - MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br />AppI. Recd~ 220 High St. N,E. 2nd Floor ~E~'INo,, <br /> Salem, Oregon 97301 <br /> <br /> 588-B147 - 588-5148 <br />Oate~ H~ch 13. 198~ 5::00 .......... CODE.A.Phone 588-5373 ........... 8::00 Date:: <br /> <br /> ( .... :--,-/ ~ . _ ~ Ores~Stat~ Park~ <br /> --~ ' ~il tO; ~ Traae S~ S.E. Salem 97310 <br />Owner; U. S. Forest Semite Phone:~ Address:~ <br /> Laased by Ore,on State Parks <br />BId~. & NO ' Phone; Address;_ <br /> <br />Ptans by:; Phone; Address; <br />Use of Bldg ]oN~OoB~;;~, ~M~tnbRackeqs::' Front <br /> <br />LOt No BIk. No.4 ............. Sub dv <br />Area of Bld9 2nd Base- Total <br />Main Fir: Fir,,= ........... ment:__ Area: ............ <br /> <br />Roof Type~ .......... Truss / Sfick~ .......... <br /> <br /> Park 104ac <br />Lot Size ............. Corner?__ <br /> <br /> Valuation _ ...... <br /> B J"lg .. Permit <br /> Fee: ( + 5%) <br />Water <br />Supply= ....... Elect,, Fee= ..... <br /> <br />Heating Wood <br />System~ ......... Stove- <br />Septic Tank New <br />Site Evah In~tal <br />Exist No, <br />System= ................................... Gals <br /> <br />VALIDATIONS:: <br />Zoning: Mechanical: <br />Date:: ~ J ~ <br /> Date:: <br />Septic Tank:: ill V ~ -- ._.,c'~;I Plans: <br /> <br />State DSQ charselS.00 <br />Surcharge <br /> <br />Plans Chk. Fee , <br />Septic Tank 50.00 <br />Permit Fee= <br /> <br />I agree to build accor&ng to the submitted plans and specifications, the laws of the State DEQ Surcharge=__ <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 a property I own or occupy <br />( ) I am a registered builder OR ( ) the authorized ( <br /> representative of a registered builder ( <br /> <br /> RECEIPTNO, ~, ?~_ <br />The work will be performed by a registered budder <br />Other (please specify) <br /> <br />REMARKS <br /> <br />SIGNATURE OF APPL_IC'AN] _ <br /> <br /> PLEASE NOTE:: Driveway and sidewalk inspections are required by Public Works 588-S036 <br /> Other permits requked by this dept Plumbing J-~ Electrical J--[ <br /> <br /> <br />