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MARION COUNTY <br />.~= _~7'?.//.~;~ DEPT. OF BUILDING iNSPECTION <br /> Senator Building #225 ~"'~ ~ <br />Appl. Revd: '!' '= ,7 220 High St,, N,,E,, 2nd Floor ....... No,, <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588-5148 <br /> '/'/ 5;;00 P.M- .......... cODF-A.Phone 588-5373 ........... 800 A.M, Date'~ ~'-- <br /> <br />Tax Lot No:: <br /> <br />Sec,, ~ _Twnshp, <br /> <br />8 Rge 1W <br /> <br />Address: Z ' ~ "' "~ <br /> <br />Bldr. & No" Phone: Address: <br /> <br />Plans by;; Phone; Address: <br /> Map Page ~rl~" ' Fire Zone Type of Const <br /> Zone Chg Part Cond. Use Variance <br /> <br />U~ O{ Bids ;: orN°occBdrmS'Ld " Setbacks::Min R~ Front ~ Sides J Rear <br /> <br />LOt NO:: __Blk, NO; Sub dv. <br /> <br />Lot S ze - f~: ~ Corner? <br /> <br />Water Supply: <br /> <br />Sewage Site <br />Disposal; -- Evah <br /> No. <br />Area of Bids; Stories: <br /> Roof <br />9asement: Type; <br />Heating <br />System; <br /> <br />Valuation: ~; <br /> <br />Permit Fee;;. <br /> <br />State Surcharge:: <br /> <br />Plans Chk. Fee: <br /> <br />Septic Permit Fee: <br /> <br />BTU:: <br /> <br />NS: <br /> <br />Total Fees: ...... <br /> <br />Rcpt. No: <br /> <br />PLANS <br /> <br />I agree to bui/d according tO the submitted p/ans and specifiCatiOns, the laws of the State of Oregon and the Oridnanc'es of Mar/on <br />County. Permit expiYes if work not commenced within 120 days. I forhter ~xpressly warrant that I comply with the provi$JO~s of ORE <br />70 ~. ~5 ~o 70 ~. 125 because' <br />( ) / am a r~stered builder or ( ) tho author)~ representative of a r~i~tered builde~ , ~iaai~ ~ <br /> <br />( ) I e~ performin~ work on a property I own or occupy ~ ~tm mint t~st ~ ob~ne~ <br />( ) Other (please ~p~'i~y) ~ ~ ~ ~ ~ <br /> <br />I have read thi~ appbcation in its entikety and certify that the stated information is true and correct to the best of rny kr~ow/edEe <br /> <br />SIGNATURE OF APPLICANT ~.('~{'~LJ ~'~"~ <br /> PLEASE NOTE:: Driveway and s~e~,valk inspections are requlr(e~ by Public Works:: <br /> Other permits required by this dept;; Plumbing r~ Electrical <br /> <br />588-5036 <br /> <br /> <br />