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biOn,~Jy <br />Appk Reed: <br /> <br />Date:: ?/~:] /P ': <br /> <br /> MARION COUNTY <br /> DEP;L OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St., N.E,, 2_nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588-B147 - 588-5148 <br />5:00 P.M.. ........... CODE.A-Phone 588-5373 ........... 8::00 A,,M,, <br /> <br />Type of Permit:: <br /> <br />Address:: <br /> <br />Owner;; <br /> <br />Bidr,, & No,: <br /> <br />Plans by,' <br /> <br /> Map Page <br /> <br />Use of 81dg,:: <br /> <br />Phone:__]' ~ <br /> <br />Phone: <br /> <br />Address: <br /> <br />Tax Lot No;; <br /> / <br /> <br />Twnshp, 4-~ Rge, ~ <br /> <br />Type of ConsL <br /> <br />Front <br /> <br />ReBr <br /> <br />Lot No. <br />Area of Bldg, <br />Main Fir,::_ <br /> <br />__BIk,, No,= .... Sub dv ..... <br />2nd Base- Total <br />FIr.~. ment: Area: I <br /> <br />Roof Type:: <br />Heating <br /> <br />Septic Tank <br />Site Evoh <br /> <br /> Truss/Stick: ....... <br />Wood Water <br />Stove= .... Supply~ <br /> <br />Exist <br />System: <br /> <br /> New <br /> Instal <br /> No,, <br />____ <br /> <br />VALIDATIQ.NS= <br />Zoning:: 7 <br />Septic Tor~ <br /> <br />I agree to build according to the submitted plans and specifications, the laws of the State <br />of Oregon and the Ordinances of Marion County, Permit expires if work not commenced <br />w~thin 180 days, I further expressly warrant that I comply with the provisions of ORS <br />701,005 to 701 125 because <br />( ) I am performing work on a property I own or occupy <br /> ) I am a registered budder OR ( ) the authorized <br /> representative of a registered builder <br /> <br />Lot Size ~ ~' , '~Corner?.__ <br /> <br />' '~C Valuation:. <br />Bldg,, Permit <br />Fee:~ i ,,, <br /> <br />Elect. Fee= <br /> <br />Mech. Fee: <br /> <br />Plumb, Fee= <br />State <br /> <br />Plan~ Chk Fee~~ <br />Septic T a n k ~..~.~l <br />Permit ~ee~. <br /> <br /> DEQ Surcharge~ ° <br /> <br /> TOTAL FEE i i 7,4 0 <br /> RFCEIPT NO 40~(~ ' <br />The work will be performed by a registered builder <br />Other (p/ease specify) <br /> <br />REMARKS:: <br /> <br />SIGNATURE _ ~ <br /> PLEASE NOT~ Driveway and sidewalk inspections are required by Public Works:: 688.5036 <br /> Oth~_er.-perm~ts requ~recL~v-~[s_de~t;; Plumbing [~"i:l~ctrical ~_~- <br /> <br /> <br />