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MARION COUNTY <br />· - "Appl. R'cvd. DEPT. OF BUILDING INSPECTION <br /> 3180 Center St., N.E. <br />By: __ j.'~, Salem, Oregon 97301 <br /> R.H. WITHROW, BLDG. ADMINISTRATOR <br /> 588-5147 - 588-5148 <br /> <br /> Permit Number <br /> <br />By: ~ <br /> <br />Permit: <br /> <br />ii Phone: .... Address: <br /> <br />USe of Bldg.: ~ , Min Re(I. Front <br /> <br /> ~ ~,~' Sewage ~ <br />Lot No: BIk. No: Water Supply! L~"ff~. Disposal; <br /> <br /> Type of Const. <br /> <br />Feas. <br />Study? <br /> <br />Subdv. W,.at on: <br />Size of Lot; Corner?.-- Permit Fee: <br />Area of Bids: ....... ~ ~ ~ ~' ~ Z Plans Chk. Fee: <br />No. of Stories: / State Surcharge; <br /> <br />Basement: <br /> <br />Type of Roof: <br /> <br />Total Fees: <br /> <br />I agree to build according to the submitted plans and specifications, the laws of the State of Ore[Ion and the Ordinances of Marion <br /> <br />County. Permit expires if work not co.]~nenced withi_~ 12.~day;~, /~ /.~ . <br />SIGNATURE OF APPLICANT: ~'~'"/~'~'-'~' -~ <br />VALIDATIONS: <br />ZONING SEPTIC TANK <br />By; By; <br />Data: Data: <br /> <br />REMARKS <br /> <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works: 588-5036 <br /> Other permits required by this dept: Plumbing [] <br /> <br /> <br />