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Appl, R ec d,."~, [-¢--'.. By:~ MARION COUNTY DEPT. OF BUILDING INSPECTION Senator Building #225 220 High St.. N,E. 2nd Froot Permit No ' Salem, Oregon 97301 588-5147 -- 588-5148 By: 5:00 P.M ....................... CODE-A-Phone ...................... 8:00 A.M. Date: Plans by: Map Page I Zone I Use of Bldg.: ~,,~.~.',e..._.l?'~\C..J Tax Lot NO.:.~,,~' ~ ~' - '~O ") .~ Sec.: Twnehp.: Rge' .Phone: ________,.,~.A d d r ess: .... Part, Cond. Use / Variance/Ad j, FT/FD Occupancy Lot No.:_ BIk. No.:. Sub. dy,; Area of Bldg. 2nd Base- Total Main Fir.: .Fir.; ment:. Area: Roof Type: __ TrueD/Stick: Height: Heating Wood Water {~ t T~,~, System: %tove: Supply: Septic Tank New Site Eval,; Inatal.: Exist. No, System: VALIDATIONS: Gale.; Zoning: Mechanical. Date: Date: /~., ,,~ *.~)~ 7 Septic Tank; Plans: Date: Date: [/~ARION COUNTY BUILDING iNSPECTION / agree to build according to the submitted plans and epecifications, the lawe of the State of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK NO T COMMENCED WITHIN 180 DA YS, I further expressly warrant that I comply with the provieione of ORS 701,005 to 701.125 becauae: Type of Oonst. Lot Size: Valuation: ............ BIdg, Permit Fee: (+ 5%) Elect. Fee: Mech, Fee: Plumb. Fee: State Surcharge: (4%) ( ) The work will be performed by a regiatered builder ( ) Other (please epecify) ( ) I am performing work on a property I own or OCCUpy ( ) I am a registered builder OR ( ) the authorized repreeentative of a registered builder Plans Chk. Fee: Septic Tank Permit Fee: ...----~,.,~O · DEC Surcharge: BLDG, RECEIPT NO.; Driveway Permit Fee: Site Plan Review Fee: Public Works Receipt No.: __ REMARKS; I have read this application in ire entirety and certify that the stated information ie true and correct to the beat of my knowledge. PLEASE NOTE; Driveway and sidewalk inspection are required by Public Works; 588-5036 REV ?- es Other permits required by this dept.; Plumbing [] Electrical [] Mechanical []