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MARION COUNTY <br /> Appl. R'cvd. DEPT. OF BUILDING INSPECTION <br /> D ~ 3180 Center St., N.E. <br />By: , ~ Salem, Oregon 97301 <br /> R.H, WlTHROW, BLDG. ADMINISTRATOR <br /> <br />Date: //- ~ [ ¢ ( ~ ~ ~. ~ ~ Date: <br /> <br />Permit Number <br /> <br />Plans by: Phone: Address: <br />MapPage ' Zone i ZoneChg. P~t: Con&Use Variance F/reZone I Occupancy i Type of Const. <br /> <br /> Use of Bldg.: Setbark$:Min Req. Front ....... ~i~ee~. Rear <br /> <br /> Sewage A -¢: Feas. <br />Lot No: ~ BIk. No; __..~-~7 Water Supply: Disposal: t%L>'z4 Study? <br /> <br />Size of Lo~: ~ ComerT___ Permit Fee; ~. ~0 <br />Area of Bids; Plans Chk. Fee; <br /> <br />No. of Stories: State Surcharge: <br /> <br />Basement; =' Septic Permit Fee: <br /> <br /> Rapt, No, <br /> <br />I agree to build according to the aubmit]~d plana and specifications, the law~ of the State of Oregon and the Ordinances of Marion <br />County. Perm/~ expires if work not comt~enced within <br /> <br />SIGNATURE OF APPLICANT; <br /> <br />VALIDATIONS: <br />ZONING <br /> <br />::::::L0c. ,// <br /> <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works: 588-5036 <br /> Other permits required by this dept: Plumbing [] <br /> <br /> <br />