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Appl. Recd~ <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building Cb 225 <br /> 220 High St,, N.E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588-S147 - 588-5148 <br />5:;00 PM. .......... CODE.A-Phone 588-5373 ........... 800 A,M <br /> <br />Permit Noi 438 <br />By:: Dottle <br /> <br />Date;; 10/16/84 <br /> <br />Bldr, & No <br /> <br />Plans by:: Phone: <br />Map Pega Zone J 7oneChg '"'~b'rt,,.,., J Cond, Use J Variance J <br /> <br /> ,___ jz/12/ o <br />Lot No / / ____BIk, No,,= .... /~ Sub dv <br />Area of Bldg, 2nd Bose- Total <br /> <br />__ Phone:__ Address: <br /> <br />Address: <br /> <br /> slz{/0,__ v / vo <br /> _.Corner? ~ I~ <br />Lot <br /> <br />Roof Type: .___ Truss / Stick= <br />Heahng Wood Water <br />System= Stove~ .... Supply=__ <br />Sephc Tank New <br />Site Evak Instal,: .... <br />Exist No. <br />System= Gals <br /> <br />VALIDATIONS= <br />Zoning:: Mechanical= <br />Dote~ /~_/~1 .... Dote: <br />Septic Tank: I~/~--''-' ,,~,. , ~-),1 Plans~ 0 <br /> <br />I agree to budd according to fha submitted plans and specifications, the laws of the State <br />of Oregon and the Ordinances of Mor~on County Permit expires if work not commenced <br />w~th¢n 180 days I further expressly warrant that I comply with the prowsions of ORS <br />701,g05 tO 701 125 because: <br /> <br />( ) I om performing work on a property I own or occupy <br /> ) I am a registered builder OR ( ) the authorized <br /> representahve of o registered builder <br /> <br />Valuation <br />Bidg, Permit <br />Fee: ( 4- <br /> <br />Elect,, Fee= ...... <br /> <br />Plumb,, Fee= ..... <br />State <br />Surcharge: <br /> <br /> Plans Chk Fee: ..... <br /> Septic Tank <br /> Permit Fee: <br /> <br /> DEQ Surcharge~ <br /> '- 0 ....... <br /> T6TAL .... <br /> <br />(~) The work w~ll be performed by a registered builder <br />( ) Other (please specify) <br /> <br />REMARKS <br /> <br />t have read this application in its ~~fkh~t tZe~//, mf°¢et¢on ~ true and correct ro thebeafofmykn°w/ed;qe <br />SIGNATURE OF APPLICANT I%_ .// ~ /? ..~ ~.. kJ_6~__~..~ <br /> PLEASE NOTE ~L~veway and sMewalk inspections ara requffed by Public Works 588-5036 <br /> Other permits required by this dept;; Plumbing ~-~ Electrical L~ <br /> <br /> <br />