Laserfiche WebLink
Salem: Oregon 97301 <br /> <br />Owner US FOIST SERVICe. Phone .... ~ddressI <br /> <br /> JIM BURBY 854-3366 DE T ITO~ ~-R 2~-~E~ ~D'I~ ~£' E l o '~' <br />O~r & No P~one_ Address::_ H~ 60 BOX 320 <br /> <br />Plans by Phone Address:: ~ <br /> <br /> 10 apt ~it~ 3~ gaI per d~oo~ Ld Setbacks ~ <br /> <br />Lot No ..... BIk No _ Sub dv ...Lot Size' ]-O~orner? <br />Area of Bldg,, 2nd Base- Total <br />Main Fir :: ~ Fir merit Area:: <br /> <br />Roof Type __ Truss/Stiok Height <br />Heating Wood Water <br />System ..... Stove ___Supply;: <br />Sepbc Tank New <br />Site Eval Instal <br />Exist No <br />System:: .... Gals __ <br /> <br />VALIDATIONS <br />Zoning:: Mechanical <br /> <br />Valuation,, <br />Bldg Permit <br />Fee:: (+ 5%) <br /> <br />Elect Fee <br /> <br />Mech Fee:: <br /> <br />Plumb Fee <br />State <br />Surcharge:: ~, _{,.4 % ) <br /> <br />Date ~.~ Datel_ ~lAns Chkl Fee <br /> <br /> / <br /> <br />State of Oregon and the Ordinance~ of Mar/on County PERMIT EXPIRES IF ~ORK ~ ~ ~/~BY'- ~' '~ - - <br /> <br /> or occupy by a ,.gJstered buil~e~r~Fee L~.~' ~ I ~ ~ / / <br />( ) I am a regPstered builder OR ( ) the ( ) Other (please specify) ~Plan / ~%¢ / <br /> authorized representative of a ~ . . ' .~ [J~ ~ <br /> <br /> ~o~pt No ~ <br /> ~ST EOL~ ~ DUG <br />REMARKS <br /> <br />I have read this application in its entirety and certify that the stated ~nformation is true arid correct to the beat of my know/edge <br /> / D <br />SIGNATUREOFAPPLICANT~~'~'/'""'~ , w r 3 <br /> <br /> <br />