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Re~aiyad ' · 'ARION COUN'~BUILDING INSPECTION [ City Setback Req?.e~ments: ~: ~ ,~ ~w ~ro~ ' Hear' Zoning V~idation: ~-- ~ ';., , .,- ' 220 High Street NE ' ~ - salem, Oregon 9~01 I'~eft ~roperty Owner; ~ ...... , / ~ Phone:----~ _ ' ....Mgtling Address: Job Address; Site No.: Cros¢Street: ~0~/ O~ ~ 70~ 2 ~OO~ ~ Property Tax Lot No,; Fleet S/C Zone: Subdivision: Lot; Pa k;-- ,, Sp. Lot Width: Lot Depth: Acres; ~- Irreg. ¢: Corner; / Block; Total # Spaces: Contractor Business Name and No,: Architect/Engineer: IPhone: Phone; Address; Address: _,.--" New: [~'- Addition: [] Demo: [] Tach, Alter; [] Relocation; [] Ccc. Chg.: [] Review; Sq, Ft, Main Floor; Sq, Ft. 2nd Floor: Height of Building'. No. Stories! / B~e~oo~0 Mobile Home Mobile Hom,e ~ # d Occupancy: Width; ~_~/ Length:~'~1~ ! .~,,,'_ ............ Previous Site Evaluation #: , ! ,,-r [ -,/__ .~ Type of System: Test Holes Ready: Will call when holes ready; Proposed Bedrooms: Existing Septic System; Existing Tank Size: Existing Dralnfield Length; Date Tank Pumped', Existing Bedrooms', I have read this application in its entirety and certify that the stated information is Ilder, ( ) Other OTHER PERMITS REQUIRED ElY THIO DEPT,: PLUMBING, MECHANICAL, ELECTRICAL Use of Building: Sq. Ft. Garage: Other: Occupant Load: Valuation: Bldg. Fee: Mobile Home Fee: Fleet Surcharge: Zoning Surcharge: State Surcharge: Plans Check Fea: Site Evaluation Fee: Septic Permit Fee: I:)EQ Surcharge; Technical Review Fee: Reinapeotion Fee'. Investigation Fee: City Fee: TOTAL FEE: RECEIPT NO,; RES COM Water Supply;