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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building ~ 225 <br /> 220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br />R.H. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 -- 588-5148 <br />5:00 P.M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A.M. <br /> <br />PermitNo. ~'~ '-~Z'~ <br />By: <br /> <br />6[dr. & No.: <br /> <br />Phone:, , , Address: <br /> <br />Plans by: phone: Address; <br /> Map Page ~_~ ton. Chg./ P,rt. Cond. Usa Vari,nce I Fire Zone J O¢¢~e~¢¥ Type of Co,,t. <br /> <br />Use of No Bdrm9. Mtn Req. Front Sides Rear -- <br /> <br />BIk, No; .... Subdv. -' ; ,~ ]'[:: DO,r~) [>,",I:~ <br /> <br />Sewage -'-*~- ~ S te <br />Disposal: ~(t~ Evah <br /> No. <br />Area of Bldg: ~/F~C~0 Stories:, <br /> Roof <br /> Type: <br /> <br />Basement: <br />Heating <br />System: <br /> <br />Valuation: <br />Permit Fee: <br /> <br />State Surcharge: <br />Plans Chk. Fee: <br />Septic Permit Fee: <br /> <br />BTU: <br /> <br />'5 5 · O0 <br /> <br /> I - 40 <br /> <br /> 36.40 <br />Total Fees: <br /> <br />Rcpt. No; '~"~--~/ <br /> <br />VALIDATIONS: :~ '~ <br />ZONINGBy:/'~, ~'.~,-/~ SEPTIC TANKBy: ,,By:PLAN' ~ ~/~ l~'/~>~ lj~'~ <br />~te: ~ ~ ~ Date~ Date:· <br /> <br />I agree to build according to the subm/tt~ p/an~ and $p~ifications, ~e /a~ of the State of Oregon and the Ow(Jnances of Marion <br />County, Permit expires if ~rk ~ot commenced within 120 days, / furhter expressly warrant that I comply w/th the provisions of ORS <br />701.~5 to 701.12~ because: <br /> <br />( ) lamaregisteredbu//deror( ) theauthor/z~repre~ntatlveofareg/ster~bui/der <br />( ) The work wl//be performed by a r~ister~ builder <br />( ) I am perform/~ work on a prope~y I own or occupy <br />( ) Other (p/ease ~ify) ~,~~ ~ <br /> <br />I have read this application in its entirety and certify that the stated information i$ true and correct to the best of my knowledge. <br /> <br /> PLEASE NOTE~way~d sidewalk in;pections are req~ed by Public Works~ 588-5036 ., ~ ~ <br /> Other permits requited by this dept; Plumbing ~ Electrical ~ ~,~ <br /> <br /> <br />