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Appl, Revd: <br />By; .... <br />J')at~] --. I --, <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 /> 588-5147 - 588-5148 <br />8:;00 PM- ........... CODE-A-Phone 588-8373 ........... 8::00 A,,M,, <br /> <br />Type of Permit; <br /> <br />Bldr & No,: ,, .~ Phone: , <br /> <br />_Tax Lot No:: <br />Sec,, '~ %5 <br /> Twnshp,, __Rge <br /> <br />Address:: ?~0t ~: ,!7!..'d.: '%" : <br /> <br />Address: ...... <br /> <br />Plans by;: Phone: Address: <br />Map~,,~Page ,Z°neih D ~one Chg, ~art ......... Cond,, U~e J Variance Fire 7one J Occupancy Type of Const <br /> <br />Lot NO: BIk,, No:: ,, , Sub dv, <br /> <br />Lot Size__(~0~'l:~ Corner? <br /> <br />Water Supply;; <br /> <br />Sewage <br />DisposaJ <br /> <br />Area of Bldg; <br /> <br />Basement- <br /> <br />Heating <br />System:: <br /> <br />:(' Valuation: $ <br /> <br />Site <br />Eval ;: Permit Fee; <br />No, <br />Stories:: . . State Surcharge: <br /> <br />Roof <br /> Plans Chk. Fee; <br /> <br /> Septic'P=~,nit Fee: <br /> <br />BTUt <br /> <br />Total Fees: ..... :' <br /> <br />ZONING I~ SEPTIC TA PLANS <br /> <br />/ agree to build according to the submitted plan~ and specifications, the /a~vs of the State of Oregon end the Oridnances of Marfoe <br />County Permit expires if work not commenced w/thin 120 days I furhter expressly warrant that I comply w/th the provl$iOns of ORS <br />701005 to 701 125 because <br /> <br />( ) lamaregi~teredbuilderor( ) theauthorizedrepresentativeofaregibteredbuilder <br />( ) The work wfllbeperformedbyaregisteredbuilder <br />( ) I am performing work on a property I own or occupy <br />( ) Other (please specify) <br /> <br />REMARKS <br /> <br />I have read this apl3/icatibn in its entirety and certify.that the stated information is true and correct to the best of my knowledge <br />SIGNATURE OF APPLICANT::~~.~~~ -- <br /> PLEASE NOTE Drivew~and sidewalk inspections are required by Public Works: 588-5036 J ~ /~ <br /> Oth~ermits requ,re, by this dep,: Plumbing <br /> <br /> <br />