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F BUILDING INSPECTION <br /> , .~/ .,~ ¢-"~ '-' ~.,~.¢¢~ ],J.J~./ Senator E~ui~d ng #225 <br /> A~pl. Recd,: -r-/~-~'~~~220 High St., N.E, 2nd F~oor <br /> ~ ~ ~ _-~/~...) Salem, Oregon 97301 <br /> <br /> ................. ...................... :00 <br />~ ~p~f ~.t~~ ~¢~ ~ TaxL tN <br /> <br />Permit No,: _ <br />By: <br /> <br />Date: <br /> <br />§U~LDING INSPEO'ilUN .... <br />Bldr. & NO.:,~'z-.'C'~'L~ ,,¢'~ .~1;4.,.&_~ ,Phone:__ A~dress: <br />Plans by: ~ ~ ~ Phone: AddreSs: <br /> <br />__Twnshp.: Rge,: <br /> <br />· Variance/Adi, FT/FD Occupancy ] T~pe of Const. <br /> Min Req, Front _ Sides I Rear <br /> Setbacks: ~ ~ / <br /> <br />Lot Ne.; BJk. No.' Sub. dy.: Lot Size- , _Corner? <br />Area of Bldg, r 2nd Base- Total <br />Main FI r.: ./.~'/5- ~_F/r.: .... meet:__ , Area: / ~d~_~- ' Yeluation' <br />  Bldg. Permit <br />Roof Type: -, Trcss/Stick:.J.~,~~-'~¢-,~, Height;~,~-'¢/ ,. Fee: (+ 5%) __~.¢'~. <br />Heating Wood Water <br />System: __Stove; Supply: Elect. Fee: <br />Septic Tank New <br />Site Evaf.: Instal,: Mech. Fee: <br />Exist. No. <br />System: Gals,; __ Plumb, Fea;L , <br /> State <br />VALIDATIONS: Surcharge: <br />Zoning: Mechantcah <br />Date;_ __ Date: Plans Chk. Fee: ~'~' <br />Septic Tank: Plans; Septic Tank <br />Date: ........ Permit ee: <br /> <br />I agree to build according to the submitted plans and specifications, the laws DEQ Su charg'~, __ <br /> <br /> of the <br />State of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK <br />NOT COMMENCED WITHIN 180 DA YS. I further expressly warrant that I comply with <br />the provisions of ORS 701.005 to 701.125 because: <br /> <br />( b~)lam performing work On a property I OWn 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 />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 state¢ information is true and correct to the best of my knowledge. <br /> <br /> PLEASE NOTE: Driveway an~ sidewalk inspection are required by Public Works: 588-5036 <br /> Other permits required by this dept.: Plumbing ~ Electrical B Mechanical ~ <br /> <br /> <br />