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MARION COUNTY <br /> '~""~'- ~""~::~ DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> <br /> Salem, Oregon 97301 <br />By;; Jc~l.'~ R.H. WITHROW, BLDG. ADMINISTRATOR <br /> 588-5147 - 588-8148 <br /> 5:00 P,,M.- ........... CODE-A-Phone 588-5373 ........... 8;:00 AM <br />Date;; <br /> Date:; <br /> <br />Type of Permit; [,,f) ,~O~, , ~:.,, ;,:'[,:' 7, C ~ ~ C~z!~! ~Tax Lot NO. <br /> L~Lt.,.~ ~ ~ ..... · , <br />Address: 1'~? : :: ~ ,~,': Z, ~U ~ -~ X~JJ L.~ -,,~,,~-, Sec. /~ Twnshp. _ , <br /> )~ail: <br />Owner:: r;O , )(,~; ,,.~]~ Phone: ~qg Address;; <br /> <br />· Rgb, <br /> <br />Bldr. & No · Phone: Address:. <br /> <br />Plans by:: Phone: Address:: <br /> Map Paae 1 Z0~neC" ?one Ch~ Pert. Corld,, U~e I Variance I ~ae?one } Occupa.cy Tyl3e of Const, <br /> T <br />Use of Sldg :: ] No DOrms. IMin Req. Front Sides Rear <br /> or acc Ld~ [Setbacks' <br />I-ot NO- BIk, No;; Sub dy, '~- Lot Size Corner? ,, ' -. ...... <br /> Valuation: <br /> <br />Water Supply; .: <br /> <br />Area of Bldg; 10 x I~0 Stories: <br /> Roof <br />Basement:: no Type: <br />Heating <br /> <br />Permit Fee: .L2oO0 <br /> <br />1 .... State Surcharge: 1 · 40 <br /> <br />Plans Chk. Fee;; <br /> <br />Septic Permit Fee: <br /> <br />BTU; <br /> <br />Total Fees:: -~, <br />Rcpt. NO: <br /> <br />VALIDATIONS: <br />ZO NI N ~])ji ~j. SEPT~,~fN K PLANS <br /> <br />I agree to bugd accord/nE to the submitted plans and sp~if/cat/ons, the <br />County Permit expires/f work not commenced w/thiD 120 days. I furhter expressly warrant that I comply w/~h the prow~ions of ORS <br />701,005 to 701,125 because:' <br /> <br />( ) lamar~/$teredbul/deror( ) theauthor)zedrepresent~tiveofar~ister~bugder <br />~ ) The work wglbepefformedbyar~isfer~bugder <br />~ I am performing ~rk on a property I own or occupy <br /> <br />REMARK$:~ " <br /> <br />I have read thi$ application in its entirety and certify~ that the stated )nformat/on iS true and correct to the best of my know/edge <br />SIGNATUflE OF APPLICANT '~ <br /> PLEASE NOTE-' Driveway and sidewalk inspections are required by Public Works; <br /> 588-5036 <br /> Other permits required by this dept:: Plumbing [] Electrical []x~'~'~ <br /> <br /> <br />