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City <br />Zoning Validation; <br /> <br />Subdivision <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Diag. NO, 225 <br /> 220 High Street NE <br /> Salem, Oregon 97~I <br /> <br /> Phone 588.g147 <br /> <br /> Code-A-Phone 4:$0 RM, - 8:00 A.M, <br /> <br /> r Mailing ~dress: <br /> <br />Site No.: <br /> <br /> [?ty Setback Requirements: <br /> <br />· Front: Roar: <br />~ Right <br />[Sid~ Side: <br /> <br />PERMIT APPLICATION <br /> <br />Cross Street; <br /> <br />Property Tax Lot No.: Fleet S/C Zone: <br />Lot: Block'. <br /> <br />Mobile Homo Park; Sp. #: Total ¢ Spaces: <br /> <br />Section; F Township; Range; Zone: / Map: <br />Lot Width: t C~rner; <br />_ _ × <br /> <br />Contractor Business Name and No.: Phone: Address; <br />Architect/Engineer: Phone: Address: <br /> <br />Type of Permit; New: [] Addition; [] Demo; [] Tach, Use of Building; RES <br /> L,C)E.~,~'~¢~. Alter: [] Relocation; [~ Ccc, Chg.: [] Review: [] ~, COM <br /> <br />Height of Building: NO. Stories: SCi. Ft, Main Floor; Sq, Fl, 2nd Floor; Sq, Ft. Garage: Other: <br /> <br />Mobile Home Mobile Home # Bedrooms: Occupancy: Occupant Load'· Water Supply: <br />Width: Length; ~ <br /> <br />Proposed Septic installation: <br />Previous Site Evaluation #: <br /> <br />Type of System: <br /> <br />Test Holes Ready: <br />will call when holes ready: <br /> <br />Proposed Bedrooms: <br /> <br /> Existing Septic System: <br /> Existin~,] Tank Size; <br /> Existing Drainfield Len(lth'. <br /> T~¢e of System; t Ia ¢' <br /> .... i~ie'Tank Pump,e.d._:~ l\/ 15/8%Existing Bedrooms: ~ <br /> <br />~) I have road thi~ application in gs endrety end cedify that the st'ated infer marion ts <br /> true and correct to the best of my I<nowledge, <br /> I am porlorrning work on a property I own or occupy. <br /> I am a registered builder OR ( } the authorized representative of a registered <br /> builder· <br /> The work will bo performed by a registered builder, <br /> Other <br /> I agree to build aCcording to the submitted plans ~nd specifications, the laws of <br /> the state of Oregon and the ordin8nces of Marion County, <br /> <br /> OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br /> MC ~5-6 <br /> <br />Valuation: <br /> <br />BIdg. Fee: <br /> <br />Mobile Home Fee: <br />Fleet Surcharge; <br />Zoning Surcharge: <br />State Sumharge: <br />PLans Check Fee: <br />Site Evaluation Fee: <br /> <br />BBQ Surcharge: <br />Technical Review Fee; <br />Reinspectlon Fee; <br />Investigation Fee: <br />City Fee: <br /> <br />TOTAL FEE: <br />RECEIPT NO,; <br /> <br /> <br />