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By: L3 <br /> <br />Date: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building ~ 225 <br /> 220 H gh St.. N... . oor Perm,t <br /> Salem, Oregon 97301 <br /> R.H. WITHROW, BLDG. ADMINISTRATOR By;; <br /> 588-5147 - 588-5148 <br />5!!00 P.M,- ...........CODE-A-Phone 588-5373 ........... 8!!00 A,,M,, <br /> Date: <br /> <br />Type of Permit: ; ~"'J' "- - ' ' <br />Address;__ <br />Owner: <br /> <br />Bldr,, & No.;;. <br /> <br />Tax Lot No:: <br /> <br />Phone <br /> <br />Phone: Address: CpO~.-;,. J~i~OLL .... ':" LA.,[ ' : ' ' <br /> <br />9?034 <br /> <br />Plans by: :=~z,D] Phone: Address: <br />Map~ Page .~Zon ..... Zone Chg, ""~ ' Cond,, U~e Variance Fire Zone Occupancy ' Type of Const,, <br /> <br /> i , ~ V~*, or o¢~. Ld~ Setbacks <br /> <br />Lot No: BIk, NO:; Sub dy, Lot Size -} ;~C Corner? <br /> <br />Water Supply:: Valuation:; $ 1{)~ 000.00 <br />Sewage Site <br />D isposah ,, , Eval :: Permit Fee; b;'~ ~ (').0 <br /> No, <br />Area of Bldg; Stories:: ........ State Surcharge: <br /> Roof <br />Basement: Type:: Plans Chk, Fee: <br />Heating <br />System; Septic Permit Fee: <br /> <br />BTU: Total Fees; 80.08 <br /> <br />Rcpt, No;; <br /> <br />VALIDATIONS:: <br />ZONI .~.~..,~m SEPTIC TANK PLANS <br /> <br />Date:: ~ ~' ~ Date:: Date:: <br /> <br />I agree to build according to the submi'tted plans and specifications, the laws of the State <br />Count}/ Permit expires if work not commenced wi'thio 120 days, / furhtar expressly warrant that <br />70~.005 to 701 125 because:' <br /> <br />( ) /amar~i~teredbuilderor( ) ~eauthorzz~representatlveofar~ster~bullder <br />( ) The ~rk will be pe~orm~ by a r~Jbter~ builder <br />( ) I am performing ~rk on a property I own or occupy <br />( ) Other (p/ease ~Kify) <br /> <br />REMARES:; <br /> <br />/ have read this application in it~ entirety and certify that the stated information i~ true and correct to the best of my know/edg~ <br /> <br />SIGNATURE OF <br /> PLEASE NOTE:: Driveway and sidewalk inspections are required by~b~ic Works:: 588-,030 <br /> Other permits required by this dept: Plumbing ~ Electrical <br /> <br /> <br />