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@ I~-P~¢.~IFt~B I~1~. [DING INSPECTION <br />Appl Recd ;: _ - /'~,~'¢ ,~ 220~i~ ~, NE ~nd Floor Permit No <br /> ~. -- ~ - U, ~ Sal~regon 97301 <br /> <br /> ........ 8,,::~nlON ~_ 588-S147 -- 5aa-514~ By:: <br /> <br />~ . ~- / ~.. ~ ul~l~?UN~ CODE-A-Phone 8:00 A.M. Date:: <br /> <br />Bldr & No, <br /> <br />Phone: OC'5-F / ddress: <br />.Phone:: Address' <br /> <br />Rge __ <br /> <br />Plans by .Phone:; Address:: <br /> <br />I Min Req Front [ Sides <br />Setbacks <br /> <br />Area of Bldg, 2nd <br />Main Fir __Fir,:: <br /> <br />I/ <br /> <br />Base- Total <br /> <br />Roof Type;: Truss/Stick <br />Heating WOod <br />System:: Stove:: <br />Septic Tank New <br />Site Eval.;; Instal <br />Exist No <br />System:: __ Gals.;; <br /> <br /> Height <br />Water <br />Supply:: <br /> <br />VALIDATIONS <br />Zoning Mechanical:: <br />Date;: Date:: <br />Septic Tank:: Plans;: <br />Date Date:: <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 Marion County PERMIT EXPIRES IF WORK <br />NO T COMMENCED WITHIN 180 DA YS. I further expressly warrant that I comply with <br />the provisions of ORS 701005 to 701 125 because: <br /> <br />I am performing work on a property I own <br />or occupy <br />I am a registered builder OR ( ) the <br />authorized representative of a <br />registered builder <br /> <br />) The work will be performed <br /> by a registered builder <br />) Other (please specify) <br /> <br />.Lot Size::__Oorner? <br /> <br /> Valuation:: <br /> Bidg.. Permit <br /> Faa:: (+ 5%) <br /> <br /> Elect Fee:: <br /> <br /> Mech Fee <br /> <br />Plumb, Fee <br />State <br />Surcharge;: (4%) <br /> <br />Plans Chk Fee <br />Septic Tank <br />Permit Fee:: <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 />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 knowledge <br /> <br />SIGNATURE OF APPLICANT <br /> PLEASE NOTE:: Driveway and sidewalk inspection are required by Public Works. 588-5036 <br />MC 1~-6 <br /> Other permits required by this dept.;: Plumbing [] Electrical [] Mechanical [] <br />REV 7- e5 <br /> <br /> <br />