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,IU) ~ t~ ~ - 'DEPt., BUILDING INSPECTION <br /> , ~ ~\ _ Senator Building #225 <br />Appl Reed ~ ~'{ ~0=High St, N,E, 2nd Floor Pe~it No.: <br /> ' " - ' ~ [ ~ Salem, ~regon 973~1 <br /> <br /> :_ ...... ................... : <br /> <br />Bidr. & NO.: ....... Phone: Address: , <br /> <br />Plane by': ..... Phone: Address: <br /> MaP Ps=.' I Z0'e I Zone Ch.ngeI Pan. I Con,,UseI. V,ian~A=,. ~ ~T/FD <br /> <br />Lot Size: / ~ ~ ~*~Corner? <br /> <br />Area of Bldg. ~nd ~ase- <br />Main Fir.: .Fir,; ~_.~_.~.~ment: <br /> <br />... Area: ......... <br /> <br />Root Type: TrusS/Stlek: Height:. <br />Heating Wood Water <br />System: __ ,~tove: fiupply: <br />Septic Tank New <br />Site Eval+: Instal.; <br />Exist. NO. <br />System; ........ Gala.: <br /> <br />VALIDATIONS: <br />Zoning; Mechanical: <br />Date: ..... r~ate~ <br />Septic Tank: Plane: <br />Date: 13ate: <br /> <br />Valuation: <br />Bldg. Permit <br />Fee: (+ 5%) ... <br /> <br />Elect, Fee: <br /> <br />Mech. Fee; ........ <br /> <br />Plumb, Fee: <br />State <br />Surcharge: (4%) <br /> <br />Plans Chk. Fee: <br />Septic Tank <br />Permit Fee: <br /> <br />I agree to build according re the aObmittedplana and specifications, the laws of the <br />State of Oregon and the OrdinanCeS Of Marion County. PERMIT EXPIRES iF WORK <br />NO T COMMENCED WI THIN 180 DA Y$, I further expressly warrant that I comply with <br />the provisions of ORS 701,005 to 701.125 because: <br /> <br />I am perforrni~g work ol~ a property I Own <br />or occupy <br />l am a registered builder OR ( ) the <br />authorized representative of a <br />registered builder <br /> <br />The work will be performed <br />by a registered buil¢ler <br />Other (please aDeoify) <br /> <br />DEQ Surcharge; <br /> <br />TOTAL FEE: <br />BLDG. <br />RECEIPT NO,: ...... <br />Driveway <br />Permit Fee: <br />Site Plan <br />Review Fee: <br />Public Works <br />Receipt NO-: <br /> <br />REMARKS~ <br /> <br />I have read this application/fl its entirety and certify that the stated information is true and correct to the beat of my know/edge. <br /> <br /> <br />