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App~ Recd~ ~Y~---~ Date: 10-12~82 MARION COUNTY DEPT. OF BUILDING iNSPECTION ~enator Building # 225 220 High St., N.E. 2nd Floor Salem, Oregon 97301 588~51¢7 - ~88-5148 P,M.- ......... CODE.A-Phone 588-5373 ........... 8:00 A_M, P r; it No. Type of Permit; A dre s: Owner: Phone: 578-0025 Bldr. & No.:~ Phone: Plans by: Phone: M~p P~i. ,Zone"' Zone Chg. 1 "i~ar~- ' ~d":"'u' Tax Lot No: I Lot Size 1 ACFd~ Corner? NO Bldg, Permit Fee~ 27.55 Lot No,= .... BIk. NO.: ,Sub dy_ Area of BIdg, 2r,.d. Sa~e- Total h~ln Fir .,~.~ ~f~', ,~ ........ merit: Ama~.--....~ Elect. Fee= Roof Type~ ..... ~ ~'~]L, ....... Truss/$tick~ , Heoting Wood Wafer Sysfem~ .... Stove~ Supply~ -- Septic Yank New Site Evah _ Instal,. ,, Mech. Fee~ Exist. No. System: ...... Gals.: ............... Plumb. Feet State VALIDATION[: (~ / Surehatge~ ,,, ~ta: ................ PIons Chk, Fee~ Septic Tan~ ' P~ns= Septic Tank I ag,~-e to build accordlng to the submitted plans and specifk'otions, the laws of the State of Oregon ~nd the Ordina~ OF M~rion County, Permit e~i~s if work not ~mmen~d within 180 da~. I iu~ffier expressly werrant that I ~mply with ~e 701.005 to 701.125 { J I am ~rforming work on a property I own or occgpy { ) I am a regis~red builder OR ( ) ~e authorized ( ) The wo~ will be performed by a mgiste~d bu;Ider ~epre~ntatlve oia regi~ builder ( ~ ~her (plea~ s~dfyj DEQ TOTAL FEE*-- /:.6 RECEIPT N O. :.~~.~// REMARKS: SIGNATUR~ O~ APPLICANT: ~ ~ PLEASE NOTEt Driveway a~ Sid~alk Ins~ions 8to ~qui~ed by Public WorEs~ ~8-5036 Other ~rmks r~Uir~ by this dept: Plumbing