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Appl. R'cvd. <br /> <br />Oat. e: 1 ~/2G <br /> <br /> MARION COUNTY <br /> DEPT, OF BUILDING INSPECTION <br /> 3180 Center St., N,E. <br /> Salem, Oregon 97301 <br />R.H, WITHROW, BLDG. ADMINISTRATOR <br />588-5147 - B88-5148 <br /> <br /> Permit Number <br /> <br />By: <br /> <br />Bldg, Permit: ....... ,/ tion Permit: <br />Owner: . I./ .. ~ Phone: ?A9-2220 Address: <br /> <br />City: <br /> <br />Bldr. & No,: m':t~c~ __ Phone: ....... Address: <br /> <br />Plans by: Phone: . Address: <br />~[~//~e?~jMap P e ...... '~J~Z°ne =Zone Chg. ~srt, Cond. Use Variance II Fire.,~;[one Occupancy<~ <br />~'~e of~ Idg. ', .... Mln Req. Lr~.I Sides <br /> < ...... Setbacks: <br /> <br /> Sewage Feas. <br />Lot No: .... Elk. No: _,~ Water Supply'. , Disposal: Study? <br /> <br />Sub dy, Valuation: r $ 2S00.00 <br /> <br /> 11.0 ac~es <br />Size of Lot: Corner? Permit Fee: 23,50 <br /> <br />Area of Bldg: .2.5 X 40 '~.O0(!~,~:;q. £f-~.,, Plans Chk, Fee: <br />No. of Stories: State Surcharge; <br />Basement: Septic Permit Fee: <br /> <br />.71 <br /> <br />Type of Roof; JV[h:?AT' Total Fees; <br /> Rapt, No. ~ <br />I ~gree to b~lld according to the submitted plans and specifications, the laws of the S~te of Oregon and the Ord/~,~nc, e$ of ~ar/bn <br />County. Permi~ expires if work not commenc~ wit~'n 120 <br /> <br />SIGNATURE OF APPLICANT;' /, <br />VALIDATIONS: <br />ZONIN~~ SEPTIC TAN/ <br /> <br /> REMARKS <br /> <br />PLANS <br /> <br />PLEASE NOTE; Driveway and sidewalk inspections are reqdired by Public Works: 588,5030 <br /> Other permits required by this dept: Plumbing fi"'3 <br /> <br /> <br />