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MARION COUNTY <br /> ~= DEPT. OF BUILDING INSPECTION <br /> ///' / .. .,'~ ~ //_ Senator Building <br />Appl. Recd,~ , ~ ~~~'~/~0 High St,, N,B, 2nd Floor <br /> <br /> .... ~ M 58~51~ <br /> / / ~ 5:00 P.MI.~.~,...~..~.....CODE-~one ..................... 8:00 A.M. <br /> <br /> , ~ Sec,; ~ Twnshp,: <br />Bldr, & NO.~ ¢ ~ ~ <br /> <br />Plans by: __ <br /> <br />Permit No,: 5.57 <br />By: Dottle .. <br />Date: 1/16/86 <br /> <br /> Rue,; <br /> <br />.Phone:_ , Address:~ <br /> <br />.Phone: ,,Address; <br /> <br />Variance~Adi' I FT/FD Occupancy Type of Const. <br /> <br />Lot NO.' ..... BIk. No.' , Sub. dy,: <br /> <br />__Lot Size: <br /> <br /> Base- Total <br />..... .--Jllent:_ - Area:' '" ~ <br /> <br /> Truse/Stick:~+:-1¢L15 s Height: <br /> <br />Bids, Permit <br />Fee: (+ 5%) ,.:~ ' <br /> <br />Area of Bldg. ~ 2nd <br />Main ___ - <br /> <br />Water <br />Supply: <br /> <br />Elect, Fee: <br /> <br />Mech, Fee: <br /> <br />Plumb. Fee: <br />State <br />Surcharge: (4%) <br /> <br />Heating Wood <br />System: ....... Stove: <br />Septic Tank _ New <br />Site EvaJ,; __Instal.: <br />Exist. No, <br />System; ...... Gals.: <br /> <br />Mechanical; <br />Date: <br />Plans: <br /> <br />VALIDATI~S- <br />Date:__. <br />Septic Tank: <br />Date: ....... <br /> <br />Plans Chk, Fee; <br />Septic Tank <br />Permit Fee: <br /> <br />DEQ Surcharge: <br /> <br />TOTA. PSE; ¢p/- / <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 />0 T COMMENCED WITHIN 180 DA YS. I further expressly warrant that I compJy with <br /> <br />the provisions of OR~ 701.005 to 701. 125 because: <br /> <br />The work will be performed <br />by a registered builder <br />Other (please specify) <br /> <br />I am performing work on a property I own <br />or Occupy <br />I am a registered builder OR ( ) the <br />author/zed representative of a <br />registered builder <br /> <br /> 0't .... <br />L) <br /> <br />RECEIPT NO.: <br /> <br />Driveway <br />Permit Fee: <br />Site Plan <br />Review Fee: , <br />Public Works <br />Receipt No.; <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 />S,GNATURE OP APPL,OANT: .~ _~(~.,__~~ <br /> PLEASE <br /> NOTE: <br /> Driveway and sid~lk inspection are required by Public Works: 588-5036 <br /> Other permits required by this dept.: Plumbing [3 Electrical [] Mechanical [3 <br /> <br /> <br />