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MARION' 'COUNTY <br />· ~,~,~^~,,,~ DEPT. OF ~JJILDING INSPECTION <br />! ~tL ~'""~'~,~w"~'~"~ Senator- BuiJdi~sg #225 <br />Appl, Re,cd.: J Jar__ ~r,- I --~ [ '"" 220 High St., N.E. 2nd FlOOr Permit No.:_ <br /> ~/j J,.,~. ,,~ .... V/~.,_ , Salem, Oregon 97301 <br />By;4L~qU, Z,M~~~ 588-5147 -- 588-5148 By:_ _ <br /> · ~ _ /.-,../'~ 5:00 P M CODE-A-Phone 8-00 A M <br />°ate: .................................................... Da,e' <br />Type of Per~it:i ~)~[~:~ ~'~tL~ TaxLotNo' ' ' <br /> 2 Sou h -- ~ .............. <br />Address; t Detroit Avenue, City of Detroit Sec' ~Twnshp ....... Rge.: <br /> <br />/ <br /> <br />Plans by: __ Phone: Address: <br /> <br />Map Page I Zone J Zone Change <br />Use of BI,(~,: <br /> <br />Lot No.:_J~:~____.~BIk. No,: <br />Area of BJdg, 2nd <br />Main Fir.: Fir.: <br /> <br />Part. I Cond. Use I Variance/Adj. FT/FO Occupancy Type of Const. <br /> <br /> No. Sdrms. J Min Req. FrontI Sides Rear <br /> or Ccc. Ld.: "----" Setbacks: <br /> <br />,Sub. dv. Lot Size:~orner?, <br />Base- Tota~ ~ z~------f~/~ ~ <br />ment: Area:_ Valuation; ~ ~.x ~,~. <br /> <br />Roof Type:. __ Truss/Stick: <br />Heating Wood <br />System: __Stove: <br />Septic Tank New <br />Site Eval,: ,Instal.: <br />Exist. No. <br />System: Gals.; <br /> <br />VALIDATIONS: <br />Zoning: Mechanical: <br />Date: Date: <br />Septic Tank; Plans; <br />Date: Date: <br /> <br /> Height;. <br />Water <br />,Supply: <br /> <br />Bldg. Permit <br />Fee: (+ 0,0> <br /> <br />Eject, Fee: <br /> <br />Mech. Fee:, <br /> <br />Plumb. Fee:_ <br /> <br />Surcharge: <br /> <br />Plans Chk. Fee: <br />SeattLe, Ts n k <br />Pe'/'~ Fee: <br /> <br />I agree to build according to the submitted plans and specifications, the laws of the <br />State of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK <br />NO T COMMENCED WITHIN 180 DA Y$. I further expressly warrant that I comply with <br />the provisions 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 />D~J'cc ha rge: <br /> <br />TOTAL FEE: <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 in its entirety and certify that the stated information Is trbe and correct to the best of my knowledge. <br /> <br />SIGNATURE Of APPLICANT: ~.'~/' ~'~.~. <br /> - PLEASE NOTE: DriP'ay and '~ewaik '('~spection are required by Public Works: 585-5036 <br />Ri~v ?. 8s Other permits required by this dept.; Plumbing ~ Electrical ~ Mechanical ~ <br /> <br /> <br />