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Appl Recd::FkI-',Y <br />By ~ ~ L! i <br /> <br />Date 1_-14-,56 <br /> <br /> MA~ION'COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building #228 · , ~'-J <br /> 220 High St= N,,E 2nd Floor ~l~l~_~ <br /> <br /> ~88-5147 -- 588-5148 ¢~~ <br />5::00 PM CODE-A-Phone 8 00 <br /> <br />Address 12993 Lh]en ::o:,d ::,, :,~or_* <br /> <br />Owner ......... . .... Phone6 79-2492 <br /> "~' * ='~ ......... work 224-8380 <br />Bldr & NO Ki},z'o;~~ s ;'obilc '~;o¢~s ,,,Phone:: 981-014,6 <br /> <br />Plans by:: .Phone:: <br /> <br /> Tax Lot No <br /> <br />__ Sec,, [0 __Twnshp 4s Pge <br /> <br /> Address:: <br /> <br /> .Address:: <br /> <br /> .Address' , ......... <br /> <br />Lot NO__._, <br />Area of Bldg 2nd <br />Main Fir ..... Fir <br /> <br />BIk No' Sub dv _ <br /> <br />.merit <br /> <br />Roof Type Truss/Stick <br />Heating Wood <br />System ,Stove <br />Septic Tank New <br />S~te Eval .Instal :: <br />Exist NO <br />System __.y~ Gals <br /> <br />__Lot Size F,q ,, r-,r~,,: <br /> <br />Total <br />Area <br /> <br />V.ALIDATIONS <br />Zoning Mechanfcal:: <br />Date:: __.Date <br />Septic Tank:: Plans <br />Date ..... Date __ <br /> <br /> Height: <br />Water <br />,Supply:: ~[[ <br /> <br />Valuation <br />B]dg Permit 35.30 <br />Fee:: (,- 5%) !, 75 <br /> <br />* Elect Fee <br /> <br />Mech Fee <br /> <br />Plumb Fee:: <br />State <br />Surcharge: (4%) <br />Fleet Sure ~:Se 7.68 <br />Plans Ohk Fee:: <br /> Septic Tank <br /> 60.00 <br /> Permit Fee <br /> <br />I agree to build according to the submitted plans and specifications, the laws of the <br />State of Oregon and the Ordinances Of Mar¢on County,, PERMIT EXPIRES IF WORK <br />NO T COMMENCED WITHIN 180 DA TS, I further expressly warrant that I comply with <br />the provisions of ORS 701005 to 701 125 beeauae;' <br /> <br />( ) I am performing wor~ on a property I own ( or occupy <br />( ~) I am a registered builder OR ( ) the ( <br />authorized repreaentative of a <br />registered builder <br /> <br />) The work will be performed <br /> by a registered builder <br />) Other (please specify) <br /> <br />DEQ Surcharge <br /> <br />TOTAL FEE <br />BLDG <br />RECEIPT NO <br />Driveway <br />Permit Fee <br />Site Plan <br />Review Fee <br />Public Works <br />Receipt No <br /> <br /> .5 <br />110.83 <br /> <br />* Obt_~in Electric,~l ~ermits po coda~ for mobile home. <br /> <br />t have read this application in its entirety and certify that the stated information ia true a~d correct to the best of my knowledge <br /> <br />SIGNATURE OF APPLICANT <br /> PLEASE NOTE Driveway and sidewalk inspection are required by Public Works:: 588-5036 <br /> Other permits required by this dept Plumbing r'l Electrical 62 Mechanical [] <br /> <br /> <br />