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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> · ' ' · .... ? Senator Building # 225 <br />Apph Revd: <br /> 220 High St,, N.E. :?nd Floor <br /> Salem, Oregon 97301 <br />By: ,~r~ R.H. WITHROW, BLDG. ADMINISTRATOR <br /> ,~, ~ 588-5147 - 588-5148 <br /> <br />Date: l~:'~?~) ~-~ //~_./~) ~,~_,~ , <br /> Type of Permit; ~',,,~,,J:' ) ~.,. ~C)~ (~s .,, Tax Lot No; <br /> <br />Owner: ~ ....... D,~ i~Z%~ Phone: Address: <br /> <br />Bldr. & No.: b:OT~2,.L~,~ G ~, .. '," 'Phone; c,~ 1 ~22 Address; <br /> <br />Use of Bldg.: ~No 8drms, <br /> ~.,1,.', ,,j: dOf, ~ (~.) , <br /> <br />Lot NO: _,, BIk. No: Sub dy. __ <br /> <br />Water Supply; '~'L~X "~ <br /> <br />Address; <br /> <br />Min Raq. Front <br />Setbacks; ~ <br /> <br />By: <br /> <br />Lot Size <br /> <br />Sewage ' Si <br /> <br /> Boor <br />Basement: .= ~'n Type; <br />Heating <br /> <br />BTU: <br /> <br />Valuation: <br /> <br />Permit Fee: <br /> <br />State Surcharge; <br /> <br />Plans Chk. Fee; <br /> <br />Septic Permit Fee: <br /> <br />Total Fees: <br /> <br />Rcpt. NO: <br /> <br />Twnshp. __Pge, <br /> <br />Corner;' <br /> <br />I agree to build accord/nB to the submltte~ans and sp.~iflcat/ons, the laws of the State of OreBon and the Ordinances of Marion <br /> ,'er,,,,t ,, not ,:o,-,,¢,?d <br />SIGNATURE OF APPLICANT: ~ <br />VALIDATIONS: <br />ZONINg, , SEPTIC TANK PLANS <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 [] Electrical E~J <br /> <br /> <br />