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DEP~BUILDING INSPECTION <br />~, ~ ~enetor Building <br />~ i. ~. / 2~ High St., N.E. 2nd Floor Permit <br /> Salem, Oregon 97301 <br />COUNTY ~"--~-= ~51~ By: <br /> <br />Type of Permit: ~L~,.e ~-"~alu~tic~ ~ ~c Pe~tz.~.t <br /> <br />Tax Let No,:~40648-000 <br /> <br />A~dresa: 2074? Eiway .99E, <br />O~,ne,~ ~c,L,~ w. Maskers <br /> <br />~r~r ~Ltt'o~a,r' Or 97002 Sec.: 13 ?wnshp.: 4s .Roe.: 3.W <br />266-4143 <br />Pllone~78-2580 ...... Address: 640 N. ]~ker Dr, C_ar~y, OR <br /> <br />Bier. & No.: ............. Phone:~ddress: ......... <br /> <br />Lot No,:_. 81k. No.: Rub. dy.: ,Lot Size: 24~ 000 <br />Area o1 Bldg. 2nd Base- Total <br />Main Fir.: .. Fir.: ment:~rea: , ,, <br /> <br />Roof Type:, TrusS/Stick: . Height:~ <br />Heating Wood Water ~'~ <br />System: ~tove; ...... Supply:. <br />Septic Tank New <br />Site Brai.: Instal.: <br />Exist, No, <br />SYstem; Gels.; <br /> <br />VALIDATIONS: <br />Zoning: <br />Date: i <br />Septic Tank; ~k <br /> <br />Mechan;cal;: <br />Date: <br />Pta"': <br /> <br />Corner9 no <br /> <br />VeluatJotl~ <br />Bldg. Permit <br />Fee: (+ S%) <br /> <br />Elect. Fee; <br /> <br />Mech· Fee: <br /> <br />Plumb. Fee; <br />State <br />Surcherga:~ <br /> <br />Plans Chk. Fee: <br />~;eptic Tank <br />Permit Fee: t40.00 + '/~00 <br /> <br />I agree to build according to the <br />State of Oregon and the Ordinances <br />NOT COMMENCED WITHIN 1~0 DAYS. <br />the provisions of ORS 701.005 to 701,12 <br /> <br />( ) I am pefformfilg work On a proper~ <br /> Or <br />( ) I am a registered builder OR ( ) ~. <br /> authorized repre~entative of a <br /> registered builder <br /> <br />REMARKS; <br /> <br />~O Surcharge: 15 <br /> <br />)TAL FEE; <br />,DG. <br />!CEIPT NO.: <br />iveway <br />rmit Fee: <br />$ Plan <br />view Fee: ............... <br />31lc Works <br />;elpt No,; <br /> <br />I have ~ead this application in its entirety <br /> <br />*rre~t to the best of my knowledge, <br /> <br />S, .ATURE O ^PP.,CA.T /-/ , <br /> · PLEASE NOTE; Ortvewa~ay~~~¢itoll are required by Public Works: <br /> <br />586-5038 <br /> <br /> <br />