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S 55-. l3-0ao3s <br /> Application for Addendum to Approved Plans <br /> Marion County Public Works i -1 i <br /> 5155 Silverton Rd NE, Salem, OR 973051-V1 I C-.�(n l H�LS I I <br /> Marion ty Phone: (503) 588-5147 Fax: (503) 588-79)3 j ' ' <br /> Email: Buildingna,co.marion.or.us 16 <br /> 0RE O O N Internet address: www.co.marion.or.us itkiraca!COut:7 <br /> rsf+I_l$G 954'FC O*J <br /> An Addendum Application Cannot be Processed Without this Completed Form <br /> Original Permit Number lO - 0 Z42-3 <br /> Site Address C885 cA7A re Icrf S• <br /> Any changes that increase the square footage or changes to the footprint of the structure as <br /> approved on the original permit will require a separate building permit and is outside the scope <br /> of an addendum. <br /> Revised plans are required with the changes clouded, highlighted or otherwise identified. <br /> A fee of$67.25 per hour will be charged, with a minimum of one-half hour, due at the time of <br /> application. <br /> I request that the original permit identified above be reviewed for the following change(s): <br /> # Work not specifically listed shall not be considered part of this Addendum. <br /> Use extra pages as needed. <br /> 4111, 1. Cl a ye Inn-P. PT Zx Deck cio®a✓7S- fre.xZe'ki f <br /> Trm Can ccc,E s.c.- ./7cc- wi, ".1" <br /> gem...-, °etc-hscertiw75 <br /> 4.8P NN h A ,w J atefrekr fe✓l 4n(+r,M�'C FC/G✓ten Con ceec.tc G-.- e/ <br /> de c4r 5���"✓/ S . <br /> FILE <br /> r <br /> Signed: ` t—1Z- ?I/ i%�tyc�c�L�- r Date: 41/49I/ 3 <br /> Printed Contact Name: 1,,,,) /{6tw W Mot yrclf y'r <br /> Address of Contact Name: 85- 5/,7/,b c (i2d S St../-.-+, c✓ 973C6 <br /> Phone Number of Contact: SO 3 -- SO7 - 965- 4, <br /> E-mail Address of Contact: <br /> SCATE. -Arj" NEN <br /> iFFESj <br /> Office Use Only <br /> OK to accept PE initials <br /> CKl.s eAW <br /> GIFORMS9BLDG\B-02 Addendum Submittal 01-09,08-10.Doc �Z�,3 S 11 <br /> is• <br /> N,26 Z5 c -f <br />