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Plans by: ..... Phone' <br /> <br />Lot No,:_._....._.~J~l~. No.; ~Sub. dy,: <br /> <br />Area of Bldg. 2nd Base- Total <br />Main Fir.: __ . Fir.: _ men/:.., -Area; <br /> Bldg. Permit <br />Root Type: Trus,,~StlcK:~eJght; Fee; (+ 5%) <br />Heating WOOd .Water <br />System: Stove: ~ SOPp!y: ~~ ~'~"'~' <br />Septic Tank New <br />Site Eval.: . Instal.: L <br />Exist. NO, <br />System: ....... Gals.: ,, · <br /> <br />VAL)DATIONS: <br />Zoning:Date: ~'-' 1~ *~ "~9'~ ' Mochanieel:r3ate: <br />Date: ..... ~ Date: ., , <br /> <br />I agree to buH~ aocording to ¢he oubmitto~ p~ane an~ ap~ff~ca~[ons~ the laws of <br />State Of Oregon and the OrEInances of Mat/on CounW. PERMIT EXPIRES I~ WORK <br />NO T COMMENCED W/THIN 1~0 DA YS, / luther oxpre$a/y warrant that I comply with <br />the prOv/~ion~ of ORS 7~1.~0~ to 70L I~ becau3&' <br /> <br />( ~ I am performing work on a property I own <br /> or occupy <br />( ) I am a registered builder OR { ) the <br /> authorized representative of a <br /> registered builder <br /> <br />The work will be pa/formed <br />by a regtatered builder <br />Other (please al~ecify) <br /> <br />Elect, Fee:. <br /> <br />Meeh, Fee: .............. <br /> <br />Plumb, Fee: <br />State <br />Surcharge;,,,,, <br /> <br />Plane Chk. Fee: <br />Septic Tank <br />Permit Fee: <br /> <br />OEQ Surcharget <br /> <br />TOTAL FEE: ~ <br />EILDG. <br />RECEIPT NO.: <br />Driveway <br />Permit Fee: <br />Site Plan <br />Review Fee: <br />Public Worka <br />Receipt No,: <br /> <br />REMARK6: <br /> <br />I have read this application in its entirety and certify that the stated information ia true and correct to the best of my kl3owledge, <br /> <br /> PLEASE NOTE: Oriveway and sidewall( inspection are r~lr~ by Public Wor~s: 588-50~ <br />~V 7- aS Other permits r~uited by this dept.; Plumbing ~ Electri~l B MeChaniGal D <br /> <br /> <br />