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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br />App~evd /~. . . ~ Senator Building #225 <br /> 220 High St., N.E. 2nd Floor <br /> <br />By;; R,H, WiTHROW, BLDG. ADMINISTRATOR <br /> <br />Date::~ ~ /~ ~ ~ ~0~ 0 P,,M,,- ........... CODE-A-Phone 588-5373 ........... 8::00 <br /> <br />Owner: ~ ~~ Pho,o~ Address:~~ <br /> <br />Bldr, & NO,,: ~:~/-'/~ ' <br /> <br /> Map Page Zone JZone Chg,, <br /> / <br /> <br />Phone; Address: <br />Phone: Address; <br /> <br />Permit No. ~ <br /> <br />Twnshp, Rge, <br /> <br />_ Evah ~ <br /> No, ~ ~/I-'/' - <br /> <br />Valuetion; <br /> <br />Area of Bldg: <br /> <br />Basement;; <br /> <br />Heating <br />System; <br /> <br />,crc <br /> <br />Stories:.....*') <br /> <br />Roof <br />Type; <br /> <br />Permit Fee;; <br /> <br />State Surcharge:: <br /> <br />Plans Chk,, Fee:: <br /> <br />BTU: <br /> <br /> VALIDATIONS: <br /> ZONING SEPTIC TANK <br /> <br />By:: By::,, <br /> Da,,:: 'E' - .2. , <br /> <br /> / agree to bu#d according to the submitted plans and specifications, the laws of the State of Oregon and toe OrldnancesofMarion <br /> County, Permi't expires i~ work not commenced within 120 days, I furhter expressly warrant that / comply with the provisions of ORS <br /> 701,00~ to 701,12~ because; <br /> <br />( ) lamare~ateredbuilderor( ) theaothorlzedrepre~entativeofaregiSteredbugder <br />( ) The work wglbeper~ormedbyaregisteredbuilder <br />~ I am performing work on a prope~y I own or occupy <br />( ) Other (please specify) <br /> <br /> REMARKS:: <br /> <br />I have read this application ia its entirety and certify that the stated information is true and correct to the best of my knowledge <br />SIGNATURE OF APPLICANT'~;~::~' 4 0~j?)~ ~--~- ./,~-- t~ <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works: 588-5036 <br />Other permits required by this dept: Plumbing ~ Electrical ~ <br /> <br /> <br />