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· I' [" ~= ~:~T. OF BUILDING INSPECTION <br /> ' -~,~1 ,~,-¢ Senator Building #225 <br />Appl. Recd.:, --~I , ~i1~_ ~ ~ ~ ~20 High St., N.E. 2nd Floor Permit No.: <br />~ ~ · ~ ' ' Salem, Oregon 97301 <br /> <br /> / ~ ,, - ~ 588-5147 -- 588-514S ~Y: <br />Date ~ ~ ~" ~ ~S~ CODEAPhone 8'00AM <br />: .... . ..................... __ <br /> <br />Type of Permit: ~.Xl'~'r'! ~...,3. Lr ~-~)~j-l~ ~L,.IX.~ 01~..~ Tax LOt No.: gJ O'2_~O ~ i 1 O <br /> <br /> · , See.: .._,Lc~ Twnshp.: ~:]~ Rge,: I L~) <br /> <br />Owner: <br /> <br />Bldr, & No.:_ <br /> <br />Plans by: <br /> <br />Phone;~ddress: <br /> <br />Phone: Address: <br />Phone: ...... Address: <br /> <br />Lot No.:_ BIk. No.: Sub, dy.: <br />Area of Bids, 2nd Base- Total <br />Main Fir.: Fir,: , merit: ......... Area: <br /> <br />Roof Type: ,, Truss/Stick: Height: <br />Heating Wood Water <br />System: Stove: .Supply: ~-~ I't )z <br />Septic Tank New <br />Site Eval.: __ ~Jnstal,: <br />Exist. NO, <br />System: ~'J "~--~----> Gale.: '~ "~-~ ~ g~ <br /> ! <br /> <br />VALIDATIONS: <br /> <br />Lot Size:~Corner?~2'~ <br /> <br />Valuation;. <br />Bldg. Permit <br />Fee: (+ 5%) <br /> <br />Elect, Fee: <br /> <br />Mech. Fee: <br /> <br />Plumb. Fee: <br />State <br />Surcharge: (4%) <br /> <br />Zoning: Mechanical: <br />Date: .Date: <br />Septic Tank: Plans; <br />Date: .Date: <br /> <br />I agree to build according to the submitted plane and specifications, the laws of the <br />State o! Oregon and the Ordinances of Marion County· PERMIT EXPIRES IF WORK <br />NO T COMMENCED WITHIN 180 DA YS. I further exprasely warrant that I comply w/th <br />the prow's/OhS of ORS 701.005 to 701.125 because: <br /> <br />( ) I am performing work on a property I own <br /> 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 />Plans Chk. Fee: <br />Septic Tank <br />Permit Fee: <br /> <br />DEQ Surcharge: <br />TOTAL FEE: *] ~''' O0 <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 Jn its entirety and cartify//~att~l~ stated//p/tlon ie true and correct to <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> PLEASE NOTE: Driveway and ~alk inspection are required by Public Works: <br />MC <br />~V 7-85 <br /> <br />the best of my knowledge. <br /> <br /> 588-5036 <br />Other permits required by this dept·: Plumbing [2 Electrical [] Mechanical [] <br /> <br /> <br />