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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br />:~ll~pL__ Ret.& 2"U~c~DA¥ Senator Building # 225 <br /> <br />Type of Permit: T,,UA~I:0N Tax Lot No: .~6361-815,, 56362-~ <br /> <br />~a~m: 85fi[ ~S~ ~ ~ .... ~ 31 Twnshp ........ g,~ <br /> <br />Owner: l~SS RZES'Zl~. _ILgB. <br /> <br />phone: 759-&116 ,. Addr~$: TO ~OX ~,95 S?-~¥~:~N 97353 <br /> <br />Bldr. & No.: ...... PhOhe: Address: <br /> <br />Plans by: Phone: Addre~: <br />'P'~SP' Zo. "&g J ~'~' J P~ I ~.U. I V. kn. I Fir. Z~,' "j ..... O.~ ~ T~. <br /> R~r <br /> <br />Lot No.: ~ ,~k, No.: ......... Sub ~. <br />A~ ~ B~g. 2nd ~se* Total <br />~n Fir,; Fk.~ m~t~ ~t <br /> <br />Roof Type: Yruss/Stkk~-- , , <br />Heating wood W~er <br />System~ Stove~ Supply~ <br />~epfic T~ N~ <br /> <br />Exist, NQ. <br />System~.. <br /> <br />I agree to build according to t~ze -submitted plans and s~dfieatiom, the ~wl ef <br />of ~g~ a~ t~ O~;~n~s of Mar~ Count, ~rm~ e~;~ If ~ ~t ~m~d <br />~n ~ 80 do~. i ~r expr~Jy ~nt ~t I ~mply w~ ~ ~s~ ~ ORS <br />701,005 ~ 701. 125 <br />{ ) I em ~e~;~ ~ on a ~rty I own ~ ~upy <br /> ~ I am o reg~s~ buil~ OR ( ) the au~iz~ <br /> m~e=enfett~ ~ a m9ls~md builder <br /> <br />Lot Size~l.~~r? NO <br /> <br />Vahmtion~ <br />Bldg. Peemlt <br />Fee: ( + "=%). <br /> <br />Mech. Fee .......... <br /> <br />Plumb. Fee: _ i~ <br />,State (~' <br />S,,a'charge~ /~ <br />Plans Chk, Fee~ <br />Septic Tank <br />Pesl~if Fee: <br /> <br />DEQ 5urcho~e:~ <br /> <br /> TOTAL FEE <br /> <br />The work will be performed by a registered builder <br /> <br />I have f~d this apph~at~n itt its entirety a~ certify that the~t~ in~atlon i~ ~ue ~d ~t ~ the ~=t of my <br />SiGNATURE OF APPLICAN1 ~ ~ ~ <br /> <br />PLEASE NOTE: Driveway end sidewalk inspections are na:luired by Public Works: 588-5036 <br />Other permits require~ bY this dept: Plumbing ~ Eiecrtrical [] <br /> <br /> <br />