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Appl. Rev~'; :~'11: t ,~ <br />By: <br /> <br />Date; <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building f¢ 225 <br /> 220 High St,,, N.E. 2nd Floor <br /> Salem. Oregon 973~)1 <br /> <br /> 588-5147 - 588-5148 <br />5:00 P,M.- ........... CODE.A-Phone 588-5373 ........... 8:00 A.M, <br /> <br />Permit No,, <br /> <br />By;; <br /> <br />.ate: <br /> <br />Type of Permit;; <br />Address;; <br /> <br />Owner;; <br /> <br />~:,. ,~. <br /> <br />Phone:: <br /> <br />Map Page Z~ r; ZO~ne Chg, Part, Cond, <br /> <br /> Tax Lot No: t; !;cb o ?,~' t';: -~,31 c <br /> <br /> Sec. '~ Twnshp. i Rge <br /> <br />, Address: ~'.0. I;o% ;~L~7 :[ttil¢;%.]l.~o ?. '.: <br /> <br />Address: <br /> <br />Lot No; BIk. No: Sub dy. <br /> <br />Water Supply: <br /> <br />Sewage <br />Disposal;; <br /> <br />Area of Rid§; '~ ': ;~ <']0 <br /> <br />Heating <br /> <br />Site ,'~,:_ - <br />Eval: <br />No_ <br />Stories;:. <br /> <br />Roof <br />Type: ~L¢ ¢ .q- -- ~,~' <br /> <br />BTU:: <br /> <br /> Lot Size -_.~l~ A0:CCCorner7 -~:': <br />Valuation;; $ (,5~ 00,?% <br /> <br />Permit Fee: <br />State Surch~ge: <br />Plans Chk,, Fee:: ~ ~' :.?, <br /> <br />Septic Permit Fee:: <br /> <br />To~al Fees: <br /> <br />Rcpt. No: <br /> <br />VALIDATIQNS:: ~K .~,.~_. <br />ZONING ~/Li~ SEPTI(~ PLANS <br /> <br />I agree to bul/d according to de submlt~ plans and speclf/Catlbns, the la~ of ~e State of Or, od and the Or/dnance~ofMarion <br />County, Permit exp/r~s if ~rk not commenced wlthi~ 120 days. I furhtef expressly warrant that I comply wlth the prow~ions of ORS <br />701,~5 to 701.125 because:' <br />( )~'~m a r~i~tered builder or ( } the authorized repre~ntative of a r~ister~ builder <br />(~ The work will be pe~orm~ by ~ r~Ntered buEder <br />( ) Iamperforming~rkonaproper~lownoroccupy <br />( ) Other (p/ease ~ify} <br /> <br />REMARKS;; <br /> <br />I have read this application in its entirety and certify that the stated information is true and correct to the best of my knowl~ge <br /> <br />SIGNATUREOFAPPL,CANT;; ~ <br />PLEASE NOTE:: Driveway and sidewalk inspections are required by~Pu~Works;; 588-~36 <br />Other permits required by this dept;; Plumbing L~' Electrical E~~ <br /> <br /> <br />