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Rc.e~ By ~ ~lA'~q~ [,~L~,~¥r~T¥ I~UILDJNG INSPECTION <br /> ~ ~ ~ ~ ~lem~ Oregon 97~1 <br /> <br /> n-~oNCU~ '~ ~ ' '' <br /> BULL- ~ff;~~E ~ SE~IC ~ <br /> Pmperty <br /> <br /> Left ' <br /> <br /> PERMIT APPLICATION <br /> <br /> I Mailing A~dre~,~,, .' <br />: ~i~ NO " C~ss S~det. <br /> <br /> ~'~' - Phone. <br />Job Address <br /> <br />Se~i0n T~nship Zone; <br /> <br />, '~r~'~r'iy'Tax Lot No <br /> <br />Lot <br /> <br />Lot Depth: Acres:: Irreg. Lot <br /> [~>/ ,,, <br /> <br />Fleet $~ Zone:: <br /> <br />TOfaf # Spaces: <br /> <br />Conb'estor I~usiness Name and No-:: Phone: <br />Archit~cUEngll3eer/'-y~_/_~_.~_~ .- I , F'hono' ~ ,, <br /> <br />Type ~ Permit. r New [] Addition:: [] Demo [] Tach <br />~ IA,tar [~ ReloCatiOn: ~ Oc¢,Ct3g ~ Review <br /> <br /> ~bi~ Home j M~ile H~ ~ ~d~ O~u~n~ "" <br /> <br /> Propoeed Sep'dc Ir~,tallation;; <br /> Previous, Site EvaJu~,tion <br /> ~, ~ System <br /> ~at ~es Re~,, <br /> '" <br /> ~ill ~11 when ~Je~. ma~- ~ ~d~ <br /> Exi~i~ ~pttc SVs~- <br /> <br /> Y _ _~ I <br /> <br />OTHER PER~ITS REGUIRED ~Y 7HtS DE~.: P~MBING, MECH~AL, ELeCTriCAL <br />MC 1~ <br /> <br />' ~ of Building ' .....] RES ~ <br /> <br /> Occupant~Load~ ~-' <br /> <br />Bldg Fee: $ ....... <br />M~bi/e Home Fee ___ __ <br />Fleet 8urCh,atge: <br />Zoning Sufeha¢gG:: <br />$~te Surch~ge" . , <br />Plan~ C~ok Fee. <br /> <br />~e Ev~u~Jon F~" <br />~ptic ~rmit F.,, ~ ~_ <br />DEQ Surcharge _ ~. <br /> <br />T~hn~i Review F~: <br />~l~S~ Fee, <br />In~stlgatlon Fee~ <br />Cay ~ . ~ <br /> 0 <br /> <br />RECEIPT NO, <br /> <br /> <br />