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MARION COUNTY <br /> --P/~/~-~ DEPT. OF BUILDING INSPECTION <br /> · ¢ Senator Building # 225 <br />AppealS?vd:/;/j~/. ~ 220 High St,, N~E, 2nd Floor Permit <br /> ( J_ /~ ,~_ ~ ~ ~lem, Oregon 97301 <br />By;:~ R.H. WITHROW, BLDG. ADMINISTRATOR BV" <br /> <br />~ /~ ~ ~ 5:00 P M ............ CODE-A-Phone 5~8;~373 ....... =--8 00 A,~ - ' <br /> <br />Type of Permit:~~ }~~- ~~'~ Let No;;, ~ <br /> <br />Phone:: Add tess:: <br /> <br />Plans by; Phone; Address; <br />Map Page Zone Zone Chg. [ Part [ Cond, Ua Variance Fire Zone Occuaantv Type of Const,, <br /> <br />Use of Bldg,;: ,~ No ~drms. ~ Min ReD, Front Sides R~r <br /> <br />LOt No:: ~BIk, NO: ~ S~b dy, Lot Size~ Corner? <br /> <br />Water Supply: ~ -~ ~ <br /> Sewage . ~'.~_ - ~' Site <br /> D i s p osaI ~¢:~.~'~f~'-J?-z' .~. Evah <br /> - ~' ~/~ _-/ NO,, <br />Area of B(dg: .//.~J~ 7 Stories: <br /> Roof <br />Basement;; Type: <br />,Heating <br />System: <br /> <br />3TU:: <br /> <br />Valuation; $ <br />Permit Fe <br />State Surcharge: <br /> <br />Septic Permit Fee: <br /> <br />Toro, Fees: <br /> <br />Rcptii <br /> <br />ZONING SEPTIC PLANS <br /> <br />I agree fo bugd according ~o the ~ubmltted plans and specif/catior~s, the laws of the S~ate of Oregon and the Ondnances of Marion <br />County, Permit expires ff work not commenced withi~ 120 days. I furhter expressly warrant that I comply with the prowsions of ORS <br />701.005 to 701.12~ because: <br />( ) lamare~i~teredbul/deror( ) theauthori~edr~re~ntativeofar~ister~bu#der <br />( ) The ~rk wglbe~e~ormedbyar~ister~builder <br /> / am perfort~ihg ~rk on ~ property I own or occupy <br /> Other (please sp~ify) <br /> <br />REMARKS' <br /> <br />/ have read this applibatlbn in its entirety and certify that the stated informatibn /s ['roe and correct to the best of my know/edge <br />SIGNATURE OF APPLICANT ~ .~- ~/A ~'/~-~, ~I ~' ........ <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 />