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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION '~"<;~' <br /> Senator Building # 225 <br /> 220 High St., N.E. 2nd Floor Permit No. ,-~-/-'"¢~-..,, <br /> Salem, Oregon 97301 ~ <br /> R.H. WITHROW, BLDG, ADMINISTRATOR By: <br /> 588-{~147 - 588-5148 <br />5;00 P.M.- ........... CODE-A-Phone 588-5373 ........... 8;00 A.M. <br /> <br />Plans by; phone; Address: <br /> <br />Map Page 7one { Zone Ch9. [ <br /> <br />U~ of Bldg.: .~.~ <br /> <br />Lot No: ':' '~!:--~-- BIk. No: <br /> <br />Water Supply:,) ~ ".-Y ~:~'.-~ ,, <br />Disposal_; -~ C"~ D-~' C.,.-(_J Evah <br />Area o~Bldg;~' 1~7' ,.~ <br /> <br />P~rt. Colld. U~ Variance { Fire Zone I Occupancy Type of Const. <br /> <br /> No edrms, Min R~. Fron[ Sides Rear <br /> <br />Valuation: $ ....... <br /> <br />Basement: <br /> <br />Heating <br />System: <br /> <br />Stories: <br /> <br />Roof <br />Type; <br /> <br />Permit Fee: <br /> <br />Stat~ Surcharge; ~ <br />.... '~ ' ~' ' ~.I~'/C <br />~P~ns ~:l~k. Fee;// <br /> <br />Septic Permit f'ee; <br /> <br />BTU: Total Fees; <br /> <br />Rcpt. No; <br /> <br />VALIDATIONS; T&/ <br />ZONING SEPTIC PLANS <br />IBy. <br /> <br /> County, Permit expires ff work not commenced wlth/n 120 days. I furhter expressly warrant that I comply w/th the provisions of ORS <br /> 701,005 to 701.125 because: <br /> ( ) / am a registered builder or ( ) the au thorized representative of a registered builder <br /> ( ) The work will be performed by a registered builder <br /> ~".) / am performln~ work on a property I own or Occupy <br /> ( ) Other (p/easecpec/fy) · ~ ' ¢/ ~ ~ ; '" ~x " <br /> -'"' - -" <br /> e ' ' 'Ix>" <br /> <br /> --./"',~ , -u4.~--_.~-¢.,.~.---~-~ ~ ,~.~ ' ' <br />'./I have read thi~ application in it~ ~y and certify that the ~a~¢ in~at¢{~ true ,nd ¢o~t to the b,~t of ~y knowl¢ge, <br />SIGNATURE OF APPLICANT: ~~~ ~~/f , <br /> ~LEASE NOT~veway ~ ~equiredV~%'Pub~ie~: ' .... <br /> Other permlt~ required by this clapt: Plumbing ~ Electrical <br /> <br /> <br />