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~nr'~ r'A'4~ARION COUNTY <br /> <br /> · { ~ ~enator Bui{ding <br />AppL Re~d,;, ~ ~ , ~ ~High St,. N]E. 2nd Floo~ Permit NO.: <br /> <br /> r,~Ht mt~ t~D~PTIN~ Date', <br /> <br />.... Twnshp.: __ Rge.: ~ <br /> <br />SIdr, & No.: ...... <br /> <br />Phone;~ddresa: <br /> <br />by; <br /> <br />Phone:~ddress; <br /> <br />Area of Bldg. 2nd Ba~- Total <br />Main Fir.: __£lr.: ~,ment; Area: <br /> <br />Root Type:.__ Truss/~tick: Height: <br />Heating Wood Water <br />System: ~Stove: ...... ,Rupply; <br />Septic Tank New <br />Site Eval,', instal,: <br />Exist. NO, <br />System: Gals.: <br /> <br /> VALIDATIONS: <br /> Zoning; ,, / Mechanica/: <br /> Date; t ~/-- ~ -Date; <br /> Septic Tank: '~ ~r a ~¢, ~'} Plans: <br /> <br />I a~ree to build a~oo~din~ to the ~ubmirted plan~ end specificatlone, the laws of the <br />~tate Ct Ofe~o~ a~ the Ordinance~ of MaNon County, PERMIT EXPIRES IF WORK <br />NO T COMMENCED WI THIN 180 DA YS. I fu~her expresely warrant that I comply with <br />ehe provi31ons Of ORS 701,005 t~ 701.125 because: <br /> <br />( ~1 am performing work on a property I OWn ( ) The WOrk will be performed <br /> or occupy by a regiatered builder <br />( ) / am a registered builder OR ( ) the ( ) Other (please s~cify) <br /> authorizeE ~pre~entafive of a <br /> <br />Valuaflon;~ <br />Bldg. Permit <br /> <br />Elect. Fee: <br /> <br />Me~h, Fee:. <br /> <br />Plumb, Fee', .... <br />~tate <br />Surcharge: <br /> <br />Plans Chk. Fee: <br />Septic Tertk <br />Perm It Fee: <br /> <br />~LDG. <br />RECEIPT NO.: <br />Driveway <br />Permit Fee: <br />Site P~An <br />Review Fee; ,., <br />Public Works <br />Receipt No,: <br /> <br />REMARKS: <br /> <br /> have ~aad this application in ita /nt~ety and certify ~ilat the elated information is true a/n~eOrracl to the beat of my knowledge <br /> <br />SrGNATURE OF APPLICANT: ~ ~ - ~ ~ ~ <br /> PLEASE NOTE: Driveway and sidewalk insp~mquire~ by Public Works: 5~5036 <br />~c I 5 - 6 <br /> <br /> <br />