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Appl. Recd: ........................ <br /> ~/'~. <br />Da,e: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 43~ <br /> 220 High St.. N.E. 2nd Floor Permit No. <br /> S~lem. Oregon 97301 <br /> By: Dottie <br /> 588-5147 - B88-5148 <br />5:00 P.M.- ........... CODE-A.Phone 588-5373 ........... 8:00 A.M. <br /> <br />Date: 10/30/84 <br /> <br />Bldr. & No.: Phone: Address: <br /> <br />Plans by; Phone: Address: <br /> Zone Cond. Use Fire Zone <br />Map Fa~ie . Zone Chg. Pert..,, = Variance ' <br />useot.,.. ....... <br /> <br />Area of BJdg, 2nd Bose- Total ~ ~ ~ 9 ~ <br />Main FIr,= FIr.:~_ menh _ Areal <br /> <br />Roof Type: <br />Heatincj <br />System: ......... <br />Septic Tank <br />Site Evah <br />Exist. j/ <br />SystemL. v <br /> <br /> _ Truss/Stick; <br />Wood Water <br />Stove: ....... SUDDlY= <br /> <br />VALIDATIONS; <br />Zoning: <br />Date: <br />Septic Tank- <br /> <br />I agree to build according to the ,sui <br />of Oregon and the Ordinances of A <br />within 180 days, I further express( <br />701,005 to 701,125 because: <br />,~)1 om performing work on a prop, <br /> ) I om a registered builder OR.( <br /> representative of a registered b~ <br /> <br />Tyee of Const, <br /> <br />Front $ide. c~ J Rear <br /> <br />Lot $1Zel Il Corner.°.__ <br /> <br />Valuatiom ....... <br />Bldg, Permit <br />Fee; ( q- 5%)___ <br /> <br />Elect. Fee:, <br /> <br />Mech. Fee: <br /> <br />Plumb. Fee:_ <br />State <br /> <br />Plans Chk, Fee; <br /> <br />Septic Tank <br />Permit Fee:_ <br /> <br />DEQ Surcharge:__ <br /> <br /> / ;Z O o 0 © ,eL-11/, <br /> RECEIPT <br /> NO, <br />· formed by a registered builder <br /> <br />REMARKS: <br /> <br />SIGNATURE OF APPLICAN '~l;;llI <br /> PLEASE NC~'~; Driveway end sidewalk inspections are required by Public Works: ,588-5036 <br /> Other permits required by this dept: Ptumbing ~ Electrical [~ <br /> <br /> <br />