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Appl. Revd: <br /> <br />Date: <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 />By: ~ <br /> <br />Tax <br /> Lot <br /> No: <br /> <br />Address: q .... :~] t ;; ,irndt :do.. '.~ N.E. ~ i:.urora Sec. <br /> <br /> Moo Page Zo.e I Zone Chg. Part. I Co.d, U~ V~rle~ce Fire Zo,e Occupancy I Type of Const. <br /> <br />Lot No: ,BIk. No; Sub dv, <br /> <br />Lot Size ~Corner? __ <br /> <br />Water Supply; t'-:l ~ <br />Sewage Site <br /> <br /> No, <br />Area of Bldg; 2L~' :: I!!~ Stories: <br /> Roof <br />Basement: Type: <br /> <br />System: <br /> <br />BTU: <br /> <br />VALIDATIONS: <br />ZONING (~,~ <br /> <br />Valuation: <br /> <br />Permit Fee; <br /> <br />50.00 <br /> <br /> :". 00 <br /> <br />50o00 .,uW.:o:,i:: ": ",. <br /> <br />State Surcharge: <br /> <br />Plans Chk. Fee: <br /> <br />Septic Permit Fee; <br /> <br />Total Fees: <br /> <br />Rcpt, No; <br /> <br />I agree to build according to the submitted plans and spec/f/cations, the law~ of the State of Oreffon end the Or/dnances of Marion <br />County. Permit expires if work not commenced within 120 days. I furhter expressly warrant that I comply with the provlslons of ORS <br />701.005 to 701.125 because: <br /> <br />( ) lameregisteredbuilderor( ) theauthorlzedreprecentativeofaregNteredbuilder <br />( ) The work willbepeWormedbyaregisteredbuilder <br />( ) I am performing work on a property I own or occupy <br />( ) Other (please ~pecify) <br /> <br />REMARKS: [Isin;:] e:.:is%ill~* septic %e~k. lOOO Fal!ons d~=.,'in~ields ~ u.nkz~own <br /> <br />O!.,: .,O0:_].e kome is bc~,~l,-; re~ovc~,.. Steven o~,:._~o wil,! be ].ivin::: in mobile <br /> <br />I have read this applkat/on in /ts entirety and certify that the stated information /s true and correct to the best of my knowledge, <br /> <br />SIGNATURE OF APPLICANT: _z../ ~-.-z----:,,-~.--t.,-.~.~ <br /> PLEASE NOTE:/vDriveway and sidewalk inspections are required by Public Works: 588-5036 <br /> Other permits required by this dept: Plumbing [] Electrical-~'' -- <br /> · / / <br /> <br /> <br />