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Appl, Revd? %-~Jn, suy <br /> <br />By: ._. ~!s <br /> <br />Dgte; ,?ril 5778 <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING iNSPECTION <br /> Downtown Senator Building <br /> 220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br />Ri't, WITHROW, BLDG. ADMINISTRATOR <br />588-5147 - 588-5148 <br /> <br />Type of Permit; <br /> <br />~m~ add%ion %~ ~e.- fala}.ly room <br /> <br /> 364-3077 <br /> <br /> 9193 5haw Sq. i~d. SE. ~u~usville <br />Add,ess; <br /> <br /> Chiles ~3. ~/perly <br />Owner: Phone; <br /> <br /> TaxLotNo; ~. ~..~c..- . <br /> <br /> same 97325 <br />Address; <br /> <br />Bldr. & No.: . Phone: ,, <br /> <br />Address: <br /> <br />Zone Chg. <br /> <br /> Phone: Address; <br /> Peril Cond, Use ] Variance Fire Zone Occupancy I Type of Const, <br /> <br /> IV]in Req, Front Side~ Rea?. <br /> Setbacks: <br /> <br /> 580 x 820 no <br />Lot No: __BIk, No: Sub dy. Lot Size Corner? <br /> <br /> well <br />Water Supply; Valuation: <br />Sewage ~ e~)%ic Fees. 30..50 <br />Disposer: . Study: Permit Fee: <br /> 1.22 <br />Area of BIde: 33{) s(; :£:t. No. 1 <br /> · Stories: State Surcharge: <br /> <br /> Roof shingle- stick <br /> <br />Heating <br />System: forced air oit Septic Permit Fee; <br /> <br /> ~1.72 <br />BTU: Total Fees:_ <br /> <br />I agree to build according to the submitted plans end apecification¢, the laws of the State of Oregon and the Ordinances of Marion <br />County, Permit expires if wor~ not commenced w;th/n12~O days. <br /> <br />SIGNATURE OF APPLICANT: ¢~ ~r, ~ <br />VALiDATiONS; z / ~ <br />ZONIN~ ~~ SEPTIC TANK PLANS <br /> <br /> REMARKS <br /> <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works: 588.5036 <br />Other permits required by this dept: Plumbing [] Electrical <br /> <br /> <br />