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Appl, <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St,, N,E, 2nd Freer <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588-5148 <br />500 P,M,- ........... CODE-A-Phone 588-5373 ........... 8::00 AM <br /> <br />Permit No <br /> <br />.w <br /> <br />O ate:: <br /> <br />Bldr. & No ' Phone: Address: __ <br /> <br />Plans by:: Phone:: Address; <br />Map Page Zone Zone Chg,, Par~. ' J Cond, Use Variance Fife Zone Occu;)ancv [ Type of Caner, <br /> <br />U~e of Sldg :: [o~ ° Bclr~s'r acc. Ld: Setbacks;:MiR Req,Front Sides Rear <br /> <br />Lot No,: .... BIk No.: Sub dy ........ <br />Area of Bldg, 2nd Base- Total <br />Main FIr,~ I:Jr,~ __ menlo. Arem <br /> <br />Roof Type:: Truss / Stick: <br />Heating Wood Wafer <br />System~ ..... Stove- Supply~_ <br />Septic Tank ,(:;,~/~ ~[cz~ Instal <br />Site Eval~ <br />I~xist, No. <br />System:: Gals <br /> <br />VALIDATIONS: <br />Zoning: Mechanical~ <br />Dare ~1 ~ Date~ <br /> <br />Lot Size Corner?.__ <br /> <br />Valuation, <br />Bidg,, ,P,~.,~tA <br /> <br />Elect, Fee: __ <br />Mech, Fee: <br />Plumb. Fee= <br /> <br />Surchor~e~ ................. <br /> <br />PLans Chk Fee: ~ <br />Septic Tank <br /> <br />I agree to build according to the submitted plans and specifications, the laws of the State <br />of Oregon and the Ordinonce~ of Morion County, Permit explre~ if work not commenced <br />within 180 days I further expressly warrant that I comply with the provisions of ORS <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 />Perm, it Lee= <br /> <br />D E'~F3'~K~T~Je ~. ~'~ <br />TOTAL FEE, g' ~'/3 (~)_~? <br /> <br /> RECEIPT NO · <br />The work will be performed by a registered builder <br />Other (please specify) <br /> <br />/ have read this apphcaCiOn in it5 entirety and certify that the stated informatiO~ i~ true and~,~i~4~ to f~)~est of r~)y know/~ge <br /> <br />SIGNATURE OF APPLICANT . , ~ ~, ~ARJ~J ~,,tj~'~ ~ <br /> PLEASE NOTE:: Driveway and sidewal~nspectloCs are required by Publ~g~g: ~.~ ~ <br /> Other permits required by this dept:: Plumbing ~ Electrical ~ <br /> <br /> <br />