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
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<br />Date: l~:'~?~) ~-~ //~_./~) ~,~_,~ ,
<br /> Type of Permit; ~',,,~,,J:' ) ~.,. ~C)~ (~s .,, Tax Lot No;
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<br />Owner: ~ ....... D,~ i~Z%~ Phone: Address:
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<br />Bldr. & No.: b:OT~2,.L~,~ G ~, .. '," 'Phone; c,~ 1 ~22 Address;
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<br />Use of Bldg.: ~No 8drms,
<br /> ~.,1,.', ,,j: dOf, ~ (~.) ,
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<br />Lot NO: _,, BIk. No: Sub dy. __
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<br />Water Supply; '~'L~X "~
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<br />Address;
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<br />Min Raq. Front
<br />Setbacks; ~
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<br />By:
<br />
<br />Lot Size
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<br />Sewage ' Si
<br />
<br /> Boor
<br />Basement: .= ~'n Type;
<br />Heating
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<br />BTU:
<br />
<br />Valuation:
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<br />Permit Fee:
<br />
<br />State Surcharge;
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<br />Plans Chk. Fee;
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<br />Septic Permit Fee:
<br />
<br />Total Fees:
<br />
<br />Rcpt. NO:
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<br />Twnshp. __Pge,
<br />
<br />Corner;'
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<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
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<br /> REMARKS
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<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
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