Laserfiche WebLink
Receiv~ed By; MARION COUNTY BUILDI~IG INSPECTION <br />Oily .~enator Bldg. No. 225 <br />Zorling Validatiom . 220 High Street NE Front; <br /> Salem, Oregon 97301 { [~'t <br />Oate; ,~ Phone 588-5147 Side; <br /> Code-A-Phone 4:50 RM, - 8:00 A.M. <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />BUILDING [] <br /> <br />City Setback Requirements; <br /> <br />Right <br />Side; <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner; <br />Harold & Leann Christensen <br /> <br />~710 ~,~ SE <br />Salem, OR 97301 <br /> <br />(503) 399-9627 <br /> <br />Site No,; <br /> 9620 <br /> <br />Cross Street; <br /> <br />Fleet S/C Zone: <br /> <br />Property Tax Lot No.: <br /> <br />Subdivision; Lot: Block: <br />Mobile Hdrne Park: Sp, #; Total ¢ Spaces; <br /> <br />Range: <br /> <br />5. I79999R~ <br /> <br />Zone: I Map: <br /> A~3 <br />Irreg, Lot; Corner; <br /> <br />Section', Township: <br />14 8S <br />Lot Width: Lot Depth; <br /> <br />Contra~or Business Name and NO,; Builders ~ I Phone; <br />Architect/Engineer; ' [ Phone; <br />Duane Hu~yJ (~0~) <br /> <br />Address: <br /> <br /> 2.~_~$~b~ 0 r e ~ 'Pc Qro~_~ 16 <br /> <br />Type of Permit: New; Tach. Use of Building; RES ~ <br /> Alter; Review; [] COM LJ <br /> <br />Height of Building: Sq. Ft. 2nd Floor: Sq. Ft, Garage; Other; <br /> <br />Mobile Home <br />Width: <br /> <br />I~ Addition: [] Demo: [] <br />I~ Relocation: [] Ccc. Chg.; [] <br /> <br /> No, Stories; Sq. Ft. Main Floor: <br /> 2 plus loft <br /> Mobire Home # Bedrooms: <br /> Length; 4 <br /> <br />Occupancy; <br /> 5 <br /> <br />Occupant Load: <br /> <br />Water Supply: <br /> Well <br /> <br /> Proposed Septic, Installation; <br /> Previous Site Evaluation #; <br />___~,.p¢ of System: <br /> <br /> O~,~,,s,i;b_e Sewage <br />Test Holes Ready: y~s <br />Will call when holes ready: ,..P, roposed Bedrooms; 4 <br /> <br />Existing Septic System: <br />Existin~ Tank Size; <br /> <br />.... ,Existing DraJnfield Lencth: <br />Type of S~stern; <br />Bate Tank Pumped: Existing Bedrooms: <br /> <br /> I have read this application in its entirety ~nd certify that tee stated information is <br /> true and correct to the best of my kflOwledge. <br /> I am pedormlng work on a property I own or occupy, <br /> I am e registered builder OR ( ) the autllorized representative of a registered <br /> builder. <br /> The wOrk will be performed ~y a registered builder. <br /> Other <br /> I agree to build according to the submitted plans and specifications, the laws of <br /> tl~e state of Oregon end the ordinances of Marion County. <br /> <br />SIGNATUR~ OF APPLJCANT: <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMSIN,G, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev. 12187 <br /> <br />Valuation; $ __ <br />Bldg, Fee; $ <br />Mobile Home Fee: <br />Fleet Surcharge; <br />Zoning Surcharge; <br />State Sumharge: <br />Plans Check Fee: <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee: <br />Relnspectlon Fee: <br />Investigation Fee; <br />City Fee: <br />TOTAL FEE: <br />RECEIPT NO,; <br /> <br /> <br />