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",~ 'L~: <br />Appl. Revd- <br /> <br />By; <br /> <br /> MARION COUNTY <br /> DEIT¢. OF~UILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St, N,,E,, 2nd Ftoor <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588-5148 <br />5:00 P.M- ........... CODE-A-Phone 588-5373 ........... 8:00 A,M <br /> <br /> tNo, <br /> By: ~ <br /> <br />T~rmit: <br /> <br />Address; ,~__ ........... ~.~,' : .... <br />Owner:~ , i ,/ <br />Bldr. & No: <br /> <br />,: ,.- Phone:~!'r,;' 2:3~': Address;; <br /> <br />.Tax Lot No:: <br />Sec, /~ Twnshp.._~._~ Rge, /~-~ <br /> <br />Phone: Address: <br /> <br />Plans by;; Phone: <br /> <br /> Address: <br />Variance Fire Zone Occupancy Type of Const <br /> <br /> M in Req, Front Rear <br /> Setbacks::, Sides <br /> <br />Lot No: .BIk,, No;; Sub dv, <br /> <br /> 2_. '$!1- C'~o': <br />Lot Size ~ _Corner? <br /> <br />Water Supply: ,,,, 1 Valuation:: $ <br />Sewage Site <br />Disposal:: ~ Evah Permit Fee: <br /> No, <br />Area of Bldg; Stories:: State Surcharge:: <br /> Roof <br />Basement; ~Type; Plans Chk, Fee;; <br /> \ <br />Heating <br />System;; Septic Permit Fee;; <br /> <br />BTU: <br /> <br />VALIDATIONS: ' ~ ~,~ <br />ZONING SEPTIC PLANS <br /> <br />By- Bw <br /> <br />Total Fees: <br /> <br />Rcpt. No: <br /> <br />agree/to build according to the submitted plans and speclf/catlbns, the laws of the State of Oregon and the Oridnances of Marion <br />Count~, Permit expires if work not commenced w/thin 120 day`s, / furhter expressly warrant that I comply with the provisions of ORS <br />701,0G5 to 701,125 because' <br /> ) /I am a registered builder or ( ) the authorized representative of a registered builder <br /> ) JThe work will be performed by a registered builder -' ' does aot <br /> j ~ I ~ performi~ ~rk on a properW I ~Wn ~r ~cc~p% ' b~d on ~ ~ · ' <br /> <br /> ) ~Other (ple~e so~ify) ~on ~ m~t [itst be obt~m~ ~ <br />REMARKS:: , , ........ <br /> ) <br /> <br />I have read this applicatibn in its entiYety and, ~ that the s~a~ed information i$ true and correct to the best of my' know/edge <br /> <br />SIGNATURE OF APPLICANT:: ..... <br />PLEASE NOTE, Drkve'way and sidewalk inspections are required by Public Works~ 588-5036 <br />Other permits required by this dept: Plumbing [~ Electrical [] <br /> <br /> <br />