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MARION COUNTY <br /> DEPT. OF BUILDING iNSPECTION <br /> <br />Appl, Recd:~ T?!.u r~ci,:.,y Senator Building # 225 _~..~. ~ ~ j <br /> ...... 2;]0 High Si,, N.E. 2nd Floor Permit No. <br /> <br /> . Salem, Oregon 97301 <br />By: c~m BV; ~ <br /> 588.6147 -- 588-5148 ,~..__~ <br /> <br />~8~ 5;00 P,M,- ........... CODE-A-Phone 588.5373 ........... 8:00 A.M, Date: ~[ ' -'~ <br /> <br />Type of Permit; ~:,r,~i]~oor',~ to mobile home _Tax Lot No; .~ <br /> <br />Address: ' F>, ~ ' '- ' '~ E"', ~ 3~ J ~" r-~ Sec.~Twnshp.~ Rge,~ <br /> <br />Owner: ~,'~c:e Goe~}:]~ ~ Phone:~ ,, Add.ss: <br />Plans by: Phone; Address; <br /> <br />16185 Coon <br /> <br /> Mapeege .~_~ Zone Chg. Part, I Cond. Use Variance { Fire ;~one Occupancy Type at Const, <br /> <br />U~ of 81da.: No 8drm~. ~etba~ks: Front~) ~ ~ <br /> <br />Lot No.~ .... Bib. No.= Sub dy. ~ Lot Size~ AC~C~ Comer? <br />Are~ of Bldg. 2nd Base- Total <br />Main FIr,: ...... Fir.:_ ment;.~ A~ea:~ ~ ]8 ,-- Vobation~ ~ :~0. <br /> <br />Roof Type: __i?,;'ingCd lc~&~-'× .... /russ/Stick:_ stlC~ <br />Heating Wood Water <br />System: .......... Stove:_. _Y¢-5 __ Supply: <br />Septic Tank New <br />Site Evah Instal , <br />ExbL No. <br />System: .... Gals.: ......... <br /> <br />Bldg. Permit 6~, .05 <br />~ee: ( + <br /> <br />Elect, Fee ........ ].~ ~0~ <br />Mech. Fee 1 <br /> <br />VAL~DATIONS~ <br /> <br />Date: <br />Septic Tank: <br />Date: <br /> <br /> Mechanical: <br />__ Date: ..... <br /> <br />Plumb, Fee: <br />State <br />Surcharge; <br /> <br />Plans Chk, Fee: .., A4~ 9 q <br />Septic Tank <br />Permit Fee: .... <br /> <br />I agree to build according to the submitted plans and ~peclficatians, the laws of the 5tote DEQ Surcharge=.__ <br />of Oregon and the Ordinances of Marion County. Permit expires if work not commenced <br />within 180 day~. I further expressly warrant that I comply with the provisions of ORS TOTALFEE: <br />701.005 to 701.125 because~ <br />( )1 am performing work on a property I own or occupy RECEIPT NO.: ..... ~/~__ <br />( ) I om o regi~red builder OR ( ) the authorized ( ) The work will be performed by a registered builder <br /> representative of o registered builder ( ) Other (please specify) <br /> <br />REMARKS; <br /> <br />I have read tiffs application in it,¢ entry grid certif~ that t/~.e ¢z~ted information is true and correct to the best of rrly know/edge. <br /> <br /> LEAS NOTE; D ' away ar~sidewalk~[;'~ctions are required by Public Works: 588-5036 <br /> %'--- n~her,..P-~-',,.,"M~1'Ea-by th~s cF~DT~., '.um~ing E~---El~c~l L~ '~-~-_~.. <br /> <br /> <br />