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Appl. Revd: F~EDAY <br />By; ~A'~Y' <br /> <br />Date: 5-1-8'1 <br /> <br /> IVI/~HIUq~I ~JUUI~I I ¥ <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St.. N.E. 2nd Floor <br /> Salem, Oregon 97301 <br />R.H. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 -- 588-5148 <br />5:00 P.M,,- ........... CODE-A-Phone 588-5373 ........... 8:00 A_M~ <br /> <br />By: ./~ ~,, <br /> <br />Type of Permit; INSULATTON OI~LY <br /> <br />Address; 8033 MII~ CR~K RD AUMsvILLE <br /> <br />Owner: ~ZZABk"TH ~ <br /> <br />Phone:, 749-2599 <br /> <br /> Tax t. ot No; <br /> Sec Twnshp. __ <br />Address::__ <br /> <br />Bldr. & No.; SAL~ NOI~PROFIET ZOUS ~one: 58~--6193 Address; <br /> <br />Plans by:: Phone: Address:: <br />MapPage J Zone I ZoneChg,, Part, J Cond, U~e I Variance { FireTone ' Occupancy I TypeorCons'' ...... <br /> RESIDENCE er Oc¢. Ld:: 3 Setbacks:: <br /> <br />Lot No: 81k, No: Sub dy. Lot Size _Corner? <br /> <br />Water Supply; YfELL <br /> <br />Sewage Site <br />Disposal: S~TIO Evak <br /> No. <br />Area ofBldg; .._~.150 so. ~ ?Stories;. <br /> Roof <br />Basement;_ NO Type; <br />Heating <br />System; <br /> <br />Valuation; $ 71.5.~'O <br /> <br />Permit Fee; .... 8. O0 <br />State Surcharge: .... ?32 <br />Plans Chk. Fee;; <br /> <br />Septic Permit Fee: <br /> <br />BTU: Total Fees:_ 8-32 <br /> <br />VALIDATIONS;; <br />ZONING SEPTIC TANK PLANS .,.-~ ~ <br />Ely- By: By:: <br />o~ o~t.:: o~ ,,. -- ~,./ <br />I agree to build according to the submitted plans and ~pecif/cat/ons. the laws of [he State of Or,on and the Orldnances of Marmn <br />Couoty. Permit expwes if ~tk not com~nced w/thin 120 d~ys, / furhter expressly warrant that I cornoly w/th the provi~/ons of ORS <br />701~5 to 701,125 because: <br />( ) I am a registered builder or ( ) d~e authorized repre~ntative of a registered builder <br />( ) The~rkw~Wbepe~orm~byar~isteredbuilder <br />( ) I am performing work on a property I own or occupy <br />( ) Other (please ~ify) <br /> <br />REMARKS:: <br /> <br />I have read this application in/ts en~ety and certify that the stated info~matlon is true and correct to the best of my knowledge, <br /> <br />SIGNATURE OF APPLICANT: ~ ___ <br /> PLEASE NOTE: Driveway and sidewalk inspections are required b/Public Works; 588-§036 <br /> Other permits required by this dept; Plumbing E~] Electtica( [] <br /> <br /> <br />