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Appl. Revd; , .,~',~: <br /> <br />Date: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> · Senator Building #225 <br /> 220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br /> R.H. WITHROW, BLDG. ADMINISTRATOR <br /> 588-5147 - 588-5148 <br />5;00 P,M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A,M. <br /> <br />Type of Permit: <br /> <br />Address; ?,., <br />Owner: , <br />Bldr, & fie.: <br /> <br />Plans by: , <br /> Map Page <br /> <br /> _Tax Lot No; <br /> <br />........ Sec. ?,"~"~ ,~_~ n s h p. .. <br /> <br />Address: ...... , <br /> <br />Address; <br /> <br />Lot No: ? .BIk. No: ~ Sub dy. __ <br /> <br />Water Supply: , ~?¢'~ ~ <br />Sewage Site <br />Disposal: ~'~,~-r:fi c , Evah <br /> No. <br />Area of Bldg: ,,1 ~'~¢ ~.:,.,, r"h. Stories:. <br /> Roof <br />Basement: ;',~ Type: <br />Heating <br />System: <br /> <br /> Variance Fire Zone Occupancy J Type of Const, <br /> <br />.... <br /> <br /> Valuation: $.~ <br /> <br /> State Surcharge; '1 <br /> Plans Chk. Fee: 22.00 + <br /> Septic Permit Fee: <br /> <br /> Total Fees: <br /> Rcpt. No: ~ <br /> <br />BTU: ,, . <br /> <br />ZONING j;~/ SEPTI PLANS <br /> <br />~,: /~ .~D~.~/ 8¥: ,.~.,'~',I~Z~. ~ BY: <br /> <br />I agree to build according to the submitted plans and sp~ifications, the laws of the State of Oregon and the Orldnances of Marion <br />County. Permit expires if work not commenc~ within 120 days. I furhter expressly warrant that I comply with the provisiops of ORS <br />701,~ to 701.125 because: <br />( ) lamar~/steredbu//deror( ) theau~or/zedrepre~ntatlveofar~ister~bul/der <br />( ) The work wi//bepe~ormedbyar~isteredbu/Ider <br />( ) I am performing work on a proper~ I own or occupy <br />( ) Other (please <br /> <br />REMARKS: ..... <br /> <br />I haveread thisapplicationinit~tirety~ifY~Z~tated information is true andcorrect to thebestofmyknowledge, <br /> <br /> PLEASE NOT~ Driv~y and sidewalk inspe~ions are required by Public Works: 5~8-5036 <br /> Ot~ p;rmits required by this dept: Plumbing ~ E,ectr~a' <br /> <br /> <br />