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Appi~ Reed: TU£,~Day <br />Date: 10-].2-82 <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St., N,E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588-5148 <br />5;00 P.M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A.M, <br /> <br />Permit No.~ <br /> <br />Date: / 0,,,,,,.,--, <br /> <br />Type of Permit; C;~R?ORT <br /> <br />Address: ~673 SHAI~ S~UAP~ RD ,J~. <br />Owner: J.R~ Phone: __3 78-0025 <br /> <br />_Tax Lot No: <br /> <br /> Sec. ~Twoshp. /'~ Rge. --~ W.~ <br /> <br />Bldr, & No.: , Phone:__ Address: .... <br />Plans by: Phone: Address: <br /> <br /> C,~.~T or acc. Ld; ~etbacks: --J'~ <br /> <br />Lot No.: ..... BIk. NO.; <br />Area of Bldg. 2r~, <br />~aln I:lr..--.~-c~S~~ ° <br /> <br /> Sub dy. Lot Size 1 AC~ Corner"?_ NO <br /> Bose- Total <br /> menh Area:__ 18~20 Valuation: ]. $ (~-,,~ 0 ..... <br /> Bldg, Permit <br />Roof Type: I~iE T2'*-L Truss/Stick: Fee: ~. 27 · 55 <br />Heating Wood Water <br />System: ..... Stove- 5upply:~ Elect. Fee: <br />Septic Tank New <br />Site Eval: Instal · Mech. Fee: ...... <br />Exist, No. <br />System ...... Gals.: Plumb, Fee~ ...... <br /> State <br /> <br />Bate: ..... / ]~X Date: .... Plans Chk. Fee: ....... &7~] <br /> <br />Septic Tan~ Plans: ~__~ ~. ~ Septic Tank <br />Date ....... Dele: /~//)~ ~ Permit Fee: ..... <br /> <br />I agree to build according to the submitted plans and specifications, the lows of the State DEQ Surcharge:. <br />of Oregon and the Ordinances of Marion County, Permit expires if work not commenced <br />within 180 days. I further expressly warrant that I comply with the provisions of ORS TOTAL FEE: ....... /:6,56 <br />701.005 to 701.125 because: <br />( )1 am performing work on a property l own or occupy RECEIPT NO.- ~/~// <br />( ) I am a registered builder OR ( ) the authorized ( ) The work will be performed by a registered builder <br /> representative of a registered builder ( ) Other (please specify) <br /> <br />..................... <br /> <br /> SIGNATUREf have read thiSopapplicatiOnAPPLiCANT,~ *in its entirety~ ~and.certlfE~that ~he stated information is true and correct to the best of my know/edge. <br /> PLEASE NOTE: Driveway and sidewalk inspections ate required by Public Works: 588-5036 <br /> <br /> Other permits required by this dept: Plumbing ~ Electrical <br /> <br /> <br />