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Appl Ret,d,:, ~¢q)N)AY <br /> <br />By:: PA'f%'Y' .__ <br /> <br />Date:: <br /> <br />Type of Permit <br /> <br />Address:: <br /> <br />Bldr & No <br /> <br />Roof Type:: ..~'J'~/ <br />Heating <br />System <br />Septic Tank <br />Site Eval <br />Exist <br />System:: <br /> <br /> MARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br />senator Building #225 <br />220 High St,N E 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> S88-5147 -- 588-5148 <br /> <br /> PLBC. #20433 <br />By <br /> <br /> ~ddress:: <br /> <br /> Address., <br />Var~ance/Adj FT/FD Occupancy Type of Con~ <br /> <br /> LotSize 60x 120 Corner? <br /> Total , <br /> Area ~0 sq Ft Valuabon t~.i¢~,~ 9~750o,,0 <br /> Bldg, Permit ,50.~O <br /> Height Fee:: (+ 5%) <br /> <br />q-28-86 5 00 PM CODE-A-Phone 800 AIIMI Date;: 11-19-86 <br /> <br />LANSON _Phone::~7~ 69 Address:: SA>Z 97~ ¢ ~ .... <br />S~' _Phone:: ~~, <br /> <br />Plans by _Phone:: <br /> MD,~ ,~,h Zr, ~L Z°ne Change ~--~L~ P~r'~" '"'"'Cone Use <br /> <br />Lot No BIk N~ Sub, dy <br />Area of 8ldg 2nd Base- <br />Main Fir :: ~0 ~F~ ment <br /> ~ ~ Truss/Stick <br /> Wood Water <br /> Stove:: ~0 .... ~upply:: <br /> New <br /> Instal <br /> No <br /> Gals:: <br /> <br />VALIDATIONS:: <br />Zoning <br />Date 2¢ <br />Septic Tank <br />Date:: ____ <br /> <br />,/'~7~L Elect Fee __ ~50.00 <br /> <br />Mech Fee, <br /> <br /> Mechanical:: <br /> Date:: <br /> Plans <br /> <br />I agree to build according to the submitted plans and spacihcatione, the laws o! the <br />State of Oregon and the Ordinances of Marion County,, PERMIT EXPIRES IF WORK <br />NOT COMMENC£D WITHIN 180 D4 YS, I further e~preaaly warrant that I comply with <br />the provisions of ORS 701005 to 701,126 because: <br /> <br />) I am performing work on a property I own <br /> or occupy <br /> <br />Plumb, Fee, 55-00 <br />State <br />Surcharoe' (4%) ?.42 <br />~L:EET 15.36 <br />Plans Chk Fee 52.33 <br />Septic Tank <br />Permit Fee __ <br /> <br />DEQ Surcharge:: __ <br /> <br />TOTAL FEE <br />BLDG, <br />RECEIPT NO <br />Driveway <br />Permit Fee' <br /> <br />264.63 <br /> <br />( ) The work will be performed <br /> by a regmtered builder <br /> <br />( ) I am a registered builder OR ( ) the ( )/~ther (please specify) Site Plan <br /> authorized repreae t t e of · . ~- <br /> <br />/ha¢e read t~is appncation /n its entirety and certify that the ~teted /nformation is Irue an~oSrrgct to th~ beat of my knowledge <br />SIGNATURE OF APPLICANT ~~, ~~ <br /> PLEASE NOTE Driveway and sidewalk inspecbon are required by Public Works 588-5036 <br /> <br /> Other permits required by this dept :: Plumbing D Electrical D Mechanical g <br /> <br /> <br />