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MARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br />Senator BuHdlng # 225 <br />220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588.5148 <br />5:00 P.M.. ........... CODE-A-Phone 588-5373 ........... 8:00 A.M. <br /> <br />Permit No. ~__ <br />By: ~ <br /> <br />Address' /z/...~,~w t~ - ~ ~/ ~ Sec. Twnshp. __ <br /> <br />Owner: Phone: __ Address: <br /> <br />Rge. <br /> <br />Bldr. & No.: Phone: Address: <br />Plans by: Phone: Address: <br /> <br />U~ of Bldg.: No edrm~.' ' Mtn Req. Front gldes <br /> <br />Lot No.: ..... elk. No.: .... Sub dy. Lot Size <br />Area of Bldg~ 2nd Base- Total <br /> <br />Main Fir.- ~-~ ~' Fir ........ ment: .... Area:.-~c'~' ~' Voluation~ <br /> Bldg. Permit <br /> ~, ,~. '~"~' Truss/Stick:__ ~ Fee: ( + 5°1o) <br />Roof Type: <br />Heating0' Wood Water <br />System: ....... Stove~ Supply: Elect. Fee, <br /> <br />Septic Tank New <br />Site Evah __ Instal · Mech. Fee, <br /> <br />Exist. No, <br />System:,, __ Gals.: , <br /> <br />VALIDATIONS: <br />Zoning= <br />Dote=. <br /> <br />Septic Tank: <br />Dote: ........... <br /> <br />Mechanicah <br />Date, <br /> <br />Type of Can,t. <br /> <br /> ,,.Corner?__ <br />35.65 <br /> <br />Plumb, Fee: .... <br />State <br />Surchorge~ l, ~ ~ <br /> <br />Plans Chk. Fee:__ 23. ] 7 <br />Septic Tank <br />Permit Fee: <br /> <br />I agree to build according to the submitted plans and specifications, the laws of the State <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 <br /> <br />701,005 tO 701,125 because: <br />( ) I am performing work on a property I own or occupy <br /> ) I am a registered bu;Ider OR ( ) the authorized <br /> representative of a registered builder <br /> <br />REMARKS; <br /> <br />DEQ Surcharge: __ <br />TOTAL FEE: <br /> <br />60,2~ <br /> <br /> RECEIPT NO.: <br /> ( ) The work will be performed by a registered builder <br /> ( ) Other (please specify) <br /> <br />FUNDS TO BE TRANSFERRED FROM ROAD DEPT <br /> <br />/ have read this al~plication in /ts entirety and certify that the stated information /s true and correct to the best of my knowledge, <br /> <br /> PLEASE NOTE: D,~e'way an,~sJdewalk inspections are required by Public Works: 588-5036 <br /> Other permits required by this dept; Plumbing [] Electrical [] <br /> <br /> <br />