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Rsselva y /r _ ' M^"'O" <br /> <br />Zohing Validation: ~ <br /> <br /> BUILDING <br /> <br /> Situs Add,~ss: <br /> <br /> Use ~ Building: <br /> <br /> Mailin0 Address; <br /> <br /> ~nator B ~g. No. 225 <br /> 2~ High Street NE <br /> Salem. Omgon 97301 <br /> <br /> Phone S88-5147 <br /> Code-A-Phone 4:30 RM. - 8:00 A.M. <br /> <br />MOBILE HOME [] SEPTIC [] <br /> <br />Tax Lot; <br /> <br />Site No,; <br /> <br />Contract City; <br /> <br />Construction Type: <br /> <br />Subdivision <br /> <br />Min, Reqd. Front: <br />Setbacks: _ , <br /> <br />Lot: <br /> <br />Width: <br /> <br />Block; i Section: <br />Depth: Area: <br /> <br />Township: <br /> <br />Acres; <br /> <br />Irreg, Lot: <br /> <br /> JAN 7 <br />PERMIT APPLICATION <br /> <br />UGB; <br /> <br />BUILDING INSPECTION <br /> <br />Occupancy: Occupant Load: <br /> <br />Left Right L Re~ <br />Side: -~ Side; <br /> <br /> Zone: Map: <br /> <br />Fleet S/C Zone'. <br /> <br />Cornarl <br /> <br />Type of Permit: New: ~ Addition; [] Demo; [~ Tach, <br />~,,/~j~/~'~"- Alter: [] Relocation: [] Occ, Chg,; [] Review; <br /> <br />C(~ltractor: <br /> <br />Homa 7.o.: <br /> <br />Use of Building: <br /> RES [] <br /> <br />Acchitect/Engineer: __ L Phone; <br /> <br />No. Stories; <br /> <br />Mobile Home; Width; <br /> <br />Proposed Septic installation; <br /> Previous Site Evaluation #: <br /> Type of System: <br /> Test Holes Ready; <br /> <br />Sq. Ft. Main Floor'. <br /> <br />Length; <br /> <br />Sq, Fl, 2nd Floor: <br /> <br />Address: <br /> <br />Sq, Ft. Garage; <br /> <br />lOther: <br /> <br />Water Supply: <br /> <br /> Will call when holes ready: <br /> <br />Existing Septic System: <br /> Existing Tank Size: <br /> Existing Drainfield Length: <br /> Type of System: <br /> Date Tank Pumped; <br /> <br />Valuation: <br /> <br />( ) I have read this application in its entirety and cer~ity that the stated information is true and correCt to the best of my knowledge, <br /> <br />( ~.--'~lam~reglsteredbullderOR( )Jheauthorizedrepreaentativeof <br /> <br />( ) Other <br />( ) I agree to build ~ccordlng to the submitted plans and specifications, the laws of <br /> <br />OTHER PERMITS REQUIRED BY THIS DEP'[,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Fee; <br />Fleet Surcharge: <br />Zoning Surcharge: <br />State Sumharge; <br />Plans Check Fee: <br />Site Evaluation Fee; <br />Septic Permit Fee; <br />DEQ Sumharge; <br />Technical Review Fee: <br />Reinspection Fee; <br />Investigation Fee: <br />City Fee: <br /> <br />TOTAL FEE'. <br />RECEIPT NO,; <br /> <br /> <br />