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l:~-'~ [ ,~EPT. O'F BUILDING INSPECTION <br /> ~ ~c~o Senator Building #225 <br /> Appl Recd:: _, 220 High St, NE 2nd Floor Permit No:: <br />' .Z~..~// ,/~./~P' ]~ f~¢'] ¢¢' ~¢ Salem, Oregon 97301 <br /> By:: ~o~.:-~,.L~ ,-: " 588-5147 -- S88-5148 By:: Dottle <br /> <br />eat :oo P,,M COUE-A-Pho. AM <br /> <br />81dr & NO ::. .Phone:: Address:: <br /> <br />Plans by __.Phone;: <br /> Map Page Zone Zone Change Pert ~ ~/BcOOr~d Use ' <br /> u.eo,.dg ..... , ° <br /> <br />Lot NO:: ~52~...~81k, NO /~-~. , Sub, dvi:: <br />Area of Bldg 2nd Base- <br />Main Fir :: .Fir:: ......... ment <br /> <br />Roof Type .,, Truss/Stick:: <br />Heating Wood Water <br />System:: __ ___Stove ___Supply <br />Septic Tank New <br />Site Eval Instal:: <br />Exist NO <br />System _Gals:: ~'~2--'~-')" ~ <br /> <br /> Address:: <br />Variance/Adj FT/FD Occupancy Type of Const <br /> <br /> Min Roq Front S~des Rear <br /> <br /> C.f-,c/-.: .LctSiz.,e.,.CdoX/O/Corner? <br />Area::"/~ ~ ~- Valuation: <br /> Bidg,, Permit <br />Height' Fee:: (+ 5%) <br /> <br />Elect Fee:: <br /> <br />Mech Fee. <br /> <br />VALIDATIONS:: <br />Zoning Mechanical <br />Date ~...l~ Date <br />Septic Tanl~/},~.~ I ~_ ~l[. '~/ Plans:: .~ ~ <br /> <br />I agree to budd according to the submitted plgna andspecifications, the laws of the <br />State o! Oregon and the Ordinances of Marion County P£RMIT EXPIRMS IF WORK <br />NOT COMMENC£D WITHIN 180 DA YS I further expressly warrant that I comply with <br /> <br />the prov/s~ona of ORS 701,005 to 701 125 because <br /> <br />( ) I am performing work on s property f own <br /> or occupy <br />( ) I am a registered builder OR ( ) the <br /> authorized representative of a <br /> registered builder <br /> <br /> /.- <br />( ~/)The work will be performed <br /> by a registered builder <br />( ) Other (please spec/fy) <br /> <br />Plumb Fee:: <br />State <br />Surcharge _(_4_°/°) d~'/~ ~ <br /> <br />Permit Fee:: <br /> <br />DEQ Surcharge:: <br />FTee¢ <br />TOTAL FEE <br />BLDG <br />RECEIPT NO <br />Driveway <br />Permit Fee:: <br />Site Plan <br />Review Fee <br />Public Works <br />Receipt No:: <br /> <br />REMARKS <br /> <br />I have read this appfication in its entirety and certify that the Stated information/8 true and correct to the best of my knowledge <br /> <br />SIGNATURE OF APPLICANT ~'~'(2'~.--- ~ ~.~'~,._. <br /> PLEASE NOTE Driveway and sidewalk inspection are required by Public Works 588-5036 <br /> <br /> Other permits required by thie dept Plumbing [3 Electrical r~ Mechanical El <br /> <br /> <br />