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~ ~ MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Suilding ~ 225 <br />Appl. Recd: 220 High St., N,E. 2nd Floor Permit No..423 <br /> <br /> x 588.5147 - 588.5148 By: Dottle <br /> <br />Bldr. & No.: <br /> <br />Plans by: <br /> <br />Phone: __ Address: <br /> <br />Pho,e:~r~ ..~ ~.~';~. Address: <br /> <br />use of Bldg.'. No Bdrms, 1Min Req. Front Sides Rear <br /> <br />LotNo, ~:~ BIk. No.:~~;> Subdv. ~x~7''p~O~/~;:~ ~ L~'~/M'./~,~ <br /> <br />Area of Bldg. ~nd - Base- Tof~l ~ <br /> <br />Heating ,/,~p Wood <br />System: Stove: .... <br />Septic Tank New <br />Site Eval: *~'/~-'~ ~",~.~__~e~'_.~:~_ Instal.: <br /> <br />Exist. <br />System: ~__~/~_~'~'-/~-~c~-'~-/L~ ~.3 <br /> <br />VALIDATIONS: <br /> <br />Date, ..... <br /> <br />Water <br />Supply~ <br /> <br />Bldg. Permit <br /> <br /> 15.oo/ <br />Elect. Fee: ,4~/[d~'..~ C.i'.gO,~-~ ~r ..... <br /> <br />Math, Fee: <br /> <br /> State <br /> Surcharge .......... J. <br /> Mechanical: <br /> <br /> Date:~,~ ~/ ~ .- Permit Fee, 50.00 ~e~.9.~ <br /> C/~ 50 <br /> <br />o~ Ore,on and ~ Ordioooces of ~orlon County. Pormif ex~ires ff wor~ ~of commenced <br />within 180 days. I further expressly warrant thot l comply with the provision, Of ORS TOTAL FEE, <br /> <br /> RECEIPT NO.: <br /> ( ) The work will be performed by a registered builder <br /> ( ) Other (please specify) <br /> <br /> ., <br /> <br /> I ha va rood this oppJ ~atJon Jn J[ 'Of a cortJf h '- ' ' ', ......... ' ~' © <br /> ~ y o~ y t Ot~O stotod.in[dmoj~n is truo otM corkoct to th,o~bost of mY kno.IMge. <br /> <br /> SIGNATURE OF APPLICANT:. <br /> PL .Z ~ F ....... Y-~.~J. ~/b ~ - ~ ' <br /> EASE NOZ~~ction~ ~e reqmred 5y Pubhc WgrkS: <br /> Omar permits required by this d~pt: Plumbing ~ Electrical <br />maiZed p~mge~ ~o~ 7/29/83 <br /> <br />701,005 te 701.125 because: <br />(~)1 otn performing work on o property I own or occupy <br /> I om a registered builder OR ( ) the authorized <br /> representative of o registered builder <br /> <br /> <br />