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ApRI. Revd: PRI~,&Y
<br />By; CH:;NYL
<br />
<br />Dater
<br />
<br /> MARION COUNTY
<br /> DEPT. OF BUILDING INSPECTION
<br /> Senator Building ¢~ 225
<br /> 220 High St., N,,B,, ?-nd Floor
<br /> Salem, Oregon 97301
<br />R.B. WITHROW, BLDG. ADMINISTRATOR
<br />588-5147 - 588-5148
<br />5:00 P,,M.- ........... CODE.A.Phone B88.g373 ........... 8,00 AM,
<br />
<br /> N :W RESIDENCE
<br />Type of Permit;;
<br />
<br /> 12422 ~R'¢' PD. N.E.
<br />Add ross:i.d. Q~ X
<br />
<br />Bldr. & No '
<br />
<br />.Tax Lot No, __
<br />
<br />· .U,,O,, See,
<br /> Phone;; 678-5067 Address:: same
<br /> Address:_
<br />
<br />___Twnshp. ~9/~,,,Rge.
<br />
<br />Plans by:: Phone; Address;;
<br /> Ma~pPage ~F~J Zone cng, Part,, Cond, Use I Variance Fire Zone '[ Occueancy [ Tyae of Const
<br /> No edfms Min Req Sides .~ Rear
<br /> lo, o..,,,.::,, s.,,.c,,,x/¢
<br />
<br />Lot No:: .Blk,, No;; Sub dy,
<br />
<br />Lot Size G2AC Corner?
<br />
<br />Water Supply:: 'j'E Rlt Valuation: $ 70 :O00.OO
<br />Sewage :.,~,, _ Site
<br />Disposal: .~,~ISTING S-;PTIC Eval;; Permit Fee;__ 9P7J)O
<br />
<br /> No.
<br />Area of Bid§; up!.-,er~ 1180 Stories;; 2 State Surcharge: 9,0R
<br />lower: 1154
<br /> Roo~
<br />Basement; no Type:: ~z;'uss como Plans Chk. Fee:: ~75
<br />Heating
<br />System:; E~,EC ::tlc I.:[?::.,~.f2 Dtj~IP & i.]OC!) STCVE Septic Permit Fee;;
<br />
<br />BTU:: Total Fees;;
<br />
<br />VALIDATIONS::
<br />ZONING ,~///~.~,
<br />
<br />SEPTIC ~{A_~-
<br />
<br />292.83
<br />
<br />Rapt. NO:
<br />
<br />Date
<br />
<br />I agree to build according to the submitted plans and spacih~etiOna, the laws of the State of Oregon and the Orzdnances of Mar¢on
<br />County,, Permit expPe$ if work not comt~enced within 120 days, I furhtef expres$/7 warrant that I comply with the prow~ions of ORS
<br />70100~ to 201,125 because:
<br />
<br />( ) lamaregisteredbui/deror( ) theauthor~zedrepresentatlveofar~isteredbuilder
<br />( )~he ~rk will be performed by a r~istered builder
<br />( ~ I am performing work on a property I own or occupy
<br />( ) Other (p/ease ~ecffy) PROPOSE{} ~E:}R(::C~;;: !
<br /> EXISTI:~-;FPTIC: 1000 gallon ~RkTNi;7~LD: 400' PREVIOUS ;NDhCf'}I: 2
<br />REMARKS::
<br />
<br />I have read this application ib it~ entirety and certify that the stated information is true and correct to the beet of my know/edge
<br />
<br /> ri sidewal ec ' y Public Workst
<br />
<br />Other permits required by this dept; Plumbing [] Electrical
<br />
<br />588-5036
<br />
<br />
<br />
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