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Appl Bcvd <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 /> WITHROW, BLDG. ADMINISTRATOR <br /> 588-5147 - 588-5148 <br /> <br />Phone:: <br /> <br />Phone: <br /> <br />Lot N~ BIk NO::__ Subdv <br /> <br />Water Supply:: __ <br />Sewage Site <br />D~sposah Eval; <br /> <br />Area of Bldg; Stories:: <br /> Roof <br />Basement' - Type;: <br />Heeling <br />System:; <br /> <br />BTU_ <br /> <br />Permit No <br />By:: g'/"~' .... <br /> <br /> Address,, <br /> <br /> __ Address:: <br /> <br /> Address;; <br />.... VarJan(.a Fire Zot~e T Occupancy ~"ype of Const <br /> <br />Valuation:: <br /> <br />Permit Fee; <br /> <br />State Surcharge <br /> <br />Plans Chk Fee;; <br /> <br />Septic Permit Fee; <br /> <br />Total Fees:: <br /> <br />Lot Size .Corner? <br /> ?1.? oo <br /> <br />Rcpt, No;: , ~ /--~-~-,7 <br /> <br />I agree to build accord~/~g to the submitted plans and specifications, the lavw of the State of Oregon and the OrdflTances ot Marion <br />SIGNATURE OF APPLICANT:: <br /> <br />VALIDATIONS:: <br />ZONING SEPTIC TANK PLANS <br /> <br />Date Date Da [O <br /> <br /> REMARKS <br />If doing b~sinesa e~ described ~nder ORS 703. 055; I expressly war~ant tha~ Z o~ a <br /> <br />~egistered b~ilder p~rau~nt to the ~zboue Sta~te. <br /> <br />PLEASe NOTE: Driveway and sidewall< inspections are required by Pubhc Works: 588-§036 <br />Other permits required by this dept;; Plumbing r-I Electrical [] <br /> <br /> <br />