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MARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br />Senator Bu~ldln!~ # 225 <br /> 220 High bt,, N.E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br />588.5147 - 588-5148 <br /> <br />Permit NO, ~ <br />By: ~ <br /> <br /> ..... Tax Lot NO: . ~It'JP"~-'O(X) <br />AamsviZZe s~o._.~a Tw,~hp.8 .,, ~,1~ <br /> <br />Plans by: Phone: AckJress: <br /> '- Pm't .... l' V~riar'ce .... <br /> MepPa~"7 Zo~ Zon0Che, I ~0~ I Co~,U~ <br /> <br />Lot S;;~e. ]~t~'~rner? <br /> <br />Lot No.: ..... /ilk, No.' ..... Sub dy, <br />Area oF Bldg. 2nd Base- TOtal <br />/v~in FIr,~__ ~ Flr,~,, ment~ <br /> <br />Roof Type ..... -. Truss/Stick <br />Heating Wood Water <br />Sy~.tem~ Stove: ,. ~ ..... SuppJy~, <br />Septic 'f~nk New <br />Site Eval ........ InstaL;~ <br /> <br />System: ,, ~OIs.: .... <br /> <br />VALIDATION$~ <br />Zaning; Mechanical: <br />Date: ~! ~ ~ ._.~Dafe, ..... <br /> <br />~ ag~ to build according to the submittal plans and ~pec~ficafio~, <br />OF Oreg~ and the Ordlnonces ef Marion Courtly. Perm~ expi~ ff ~or~ not comme~ed <br />~ith]~ 180 ~oys, I further expressly warrant that I ~mply with the p~vi~ions of ORS <br />701.005 to 70 I. 125 becou~: <br />( ) I am pe~rming woek on o prope~fy I own or <br />( ) I am o registered builder OR ( ) the aut~rized <br /> representative oF o registered ha#der <br /> <br />VoluafJont . ::.. <br />Bldg. Permit <br />Fee; ( + 5%) ~. <br /> <br />h~ech. Fee~.,, <br /> <br />Plumb. Fee; ....... <br />Surcharge: . -- <br /> <br />Septic Tank <br />~rmlt Fee~ <br /> <br />TOTAL FEE: _ <br /> <br />) The work will be performed I~y a registemd builder <br />) Other (please specify) <br /> <br />SIGNATURE OF APPLiCANT:~'~~~[~ ~ - ~ ...... <br /> PLEASE NOTE. Driveway a~ sid~ inactions a~qu; ~%y Public Works: ~8-5036 <br /> Other permits r~u~r~ by tht~ de~: Pfumbin~ ~ El¢ctrica{ ~ <br /> <br /> <br />