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Appl. Revd: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br />R.H. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 - 588-5148 <br />5;00 P.M.- ........... CODE-A-Phone 588-8373 ........... 8:00 A,M. <br /> <br />Permit NO. ~0 ~/~.~--~ <br /> <br />Type of Permit: <br /> <br />.Tax Lot No; <br />Sec, Twnahp, __ <br /> <br />Rge, <br /> <br /> ~, ';:~% Phone: <br />Owner: -':~ '(~ ' ' <br /> <br />Bldr. & No.:~, :,, .......... :,'~ ,, .DL)¢/S <br />Plans by; / <br /> <br />Phone; <br /> <br /> phone; <br />F~'rt. Co,Id. <br /> <br />Address:_ <br /> <br />Address: <br /> <br />Address: <br /> <br />Variance Fire Zone Occupancy Type Of Cot~st. <br /> <br />Lot No: ]-_~Blk. No; ?. Sub dy. r~TmTD¥ Z-i' ~¥7'~ ,,., .-7~ Lot Size <br /> <br />......... Corner;' <br /> <br />Water Supply; <br /> <br />Sewage Site <br />Disposah __ Eval: <br /> ].1> :: ,.:~ No. <br />Area of Bldg: Stories: <br /> <br /> Roof <br />Basement; Type; <br />Heating <br />System: <br /> <br />BTU: <br /> <br />Valuation; $ <br /> <br />Permit Fee: i~* 00 <br />State Surcharge: ]- * L~O <br />Plans Chk, Fee: <br /> <br />Septic Permit Fee; <br />Total Fees: ' ~ <br /> <br />VALIDATIONS; <br />ZONING ~ SEPTIC TANK PLANS <br /> <br />I agree to build according to the submitted plans and specifications, ~e laws of the State of Oregon and the Oridnmzce$ o/Marion <br />County. Permit expires if work not commenced w/thin 120 days, I furhfer expressly warrant that I comply with the provls/ona of <br />70~.~5 rD 701.125 becau$e: <br />( ) lamar~isteredbu//deror( ) fheauthor/zedrepre~ntat/veofar~ister~bu/Ider <br />( ) The work will be pedorm~ by a r~i$tered builder <br /> <br />( ) Other (please ap~/fy) <br /> <br />R~MARKS: ............. <br /> <br />I have read thio application in /ta entirety and certify that/.~he stated information ia true and correct to the beat of my know/edge, <br /> // <br /> <br />SIGNATURE OF APPLICANT; ,~. <br /> <br /> PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works: 588-5036 <br /> Other permits required by this dept: Plumbing [] Electrical <br /> <br /> <br />