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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br />  Senator Building Cf 225 <br />Appl. 'l~evd: 220 High St., N.E. 2nd Floor <br /> Salem. Oregon 97301 <br /> <br /> [88-[~47 - §88-[~48 <br />Date: ~¢'~ / ~ ~. 5:00 P,M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A.M, <br /> <br />Type of Permit: ~u~_~., ~ ":~: ~ ,,Tax Lot No: <br />Addres,:~/2 '/~ ~/_ _ . <br /> <br />Owner: ~~~' Phone: Address: <br /> <br />Bldr. & No.: --~,,3~ Phone; ~7~+CJ/~--~Tv~ Address:. <br />Plans by: Phone: Address: <br /> <br />Permit No. ~77 <br /> <br />Twnshp.__Rge.__ <br /> <br />Water Supply: <br />Sewage Site <br />Disposal:__ Evah <br /> No. <br /> <br />Area of Bldg; Stories: <br /> Roof <br />Basement: Type: <br />Heating <br />System: <br /> <br />BTU; <br /> <br />Valuation; <br /> <br />Permit Fee; <br /> <br /> urcharge: <br /> <br />Plans Chk. Fee: <br /> <br />Septic Permit Fee: <br /> <br />Total Fees: ~-~--,~/~ ~ <br />Rcpt. No: :~/,~'- ~"? <br /> <br />VALIDATIONS: <br />ZONING SEPTIC TANK PLANS~-/ <br />,,8.~,'. <br />Date: Date: <br /> <br />I agree to build according to the submitted plans and spec/f/cations, the law~ of the State of Oregon and the Or/dnances of Mar~bn <br />County, Permit expires if work not commenced within 120 days, I furhter expressly warrant that I comply w/th the provisions of ORS <br />70 I. 005 to 70 ~. 125 because: <br /> <br />( ) lamareg/ateredbo//deror( ) theauthorlzedrepresentat/veofareg/steredboilder <br />( ) The work wil/beperformedbyare~jisteredbu/Ider <br />( ) I am performing work on a property I own or occupy <br />( ) Other (p/ease ~pec/fy) <br /> <br />REMARKS: <br /> <br />I have read this application in /ts entirety and certify that the stated information is true and correct to the best of my knowledge. <br /> <br />SIGNATURE OF APPLICANT: _ <br /> PLEASE NOTE: Driveway sidewalk inspections are require(~;~/Public Works: 588-5036 <br /> Other permits required by this dept: Plumbing r""l Electrical [] <br /> <br /> <br />