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Apph F~evd: <br />By: ~,, ~w~RYT ..... <br />DaW~ <br /> <br /> MARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br /> <br /> 220 H~gh St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br />Address: .... <br /> <br />Lot No: .. BIk. No: ..... Sub dy, Lot Size .'[14 AC Corner? <br /> <br />Water Supply:. %,,"gLL = : <br />Sewage .~,:XYSm.,.,,.,. ~G 5~].~EE[f;i: <br />Oi~lpo~al; ........... <br /> <br /> No. <br />~ea of Bldg: ~ Static:. <br /> <br />Heating <br />System: <br /> <br /> Valuation: ~ ~:A00.00 ........ <br /> Permft Fee: 7~. 00 <br /> <br /> i State Surcharge: 2 <br /> <br />Roof <br />Type: ~o~ & t~Lt~. Plap.~ Chk_ Fee; ~6,_~'~ ............ <br /> <br />Total Fees: <br /> <br />I afr~ ~ build ~fdi~ to ~e ~flmi~ p~ns anE ~ificat~m, ~ la~ of ~e S~te of Oran e~ ~e Ofid~$ofM~ion <br />C~n~, P~mit exp/re~ /f work not ~mme~ wiffif~ 1~ day~. I furh~ ~y wa~raflt ~at / comply with ~e p~visio~s of ORS <br />701.~ w 701. <br />( ) I am a ~i~e~ build~ ~ { } ~ eu~or~ rep~nteti~e of · r~i~ bufld~ <br /> <br />( ] Ot~ Iplea~ ~ify) <br /> <br /> SEPTIO " <br /> <br /> have read this a~pllcat~on in its entlretV and certify ~a¢ ~ S~ /nf~ma¢/on /s ~ and co~t to t~ ~t of my k~wl~ge, <br /> <br />s,~ru.~ o~ ~L~ .o~; 6,,~2, .i~'.',.,~i."~ .,. ,~.~.~ ~ ~'A"' wo.~.: ~.~. ~ 7~c ~ <br /> <br /> <br />