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Appl R ¢.~ d <br /> <br /> MARION COUNTY <br /> )F BUILDING INSPECTBON <br /> Senator Building #225 <br />220 High St, NE 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 -- 588-5148 <br /> <br />Date:: /¢2_ -~.2~;_~-.~ 5 00 PM CODE-A-Phone ..... 800 AM <br /> <br />Type of Permit .P,/~ ?~.~ Tax ~ot No" - <br />Address __/~ ~J ~*~ ~J ~,,,~ ~, _Twn;hp, <br /> <br />Permit No, __ <br />By__ <br /> <br />485 <br /> <br />Chris <br /> <br />i2-26-86 <br /> <br />Rge <br /> <br />Bldr & No ,Phone Address:: <br /> <br />Plans by:: __.Phone:: ....... ~ddress, _ <br /> <br />Lot No:: __ BIk No /-~' _Sub dv <br />Area of 131dg 2nd Base- <br />Main Fir Fir ment:: _. <br /> <br />LotS <br /> <br />Roof Type Trues/Stick:: <br />Heating Wood Water <br />System .Stove:: -Supply:: <br />Septic Tank New <br />Sale Eval :: . ___Instal:: __ <br />Exist No <br />System:: __ __Gals ,, <br /> <br />To/tel ,.~ . <br />Aroa,2,~,,~2/ C/~-,..~ Valuation <br /> Bldg, Permit <br />Height::__ Fee (+ 5%) <br /> <br />VALIDATIONS <br />Zoning Mechanical <br />Date .Date:: <br />Septm Tank:: Plans~ /"/~ <br />Date .Date _~" <br /> <br />I agree to build according to the submitted plane and specifications, the laws of the <br />State of Oregon and the Ordinances of Marion County PERMIT EXPIRES IF WORK <br />NO T COMMENCED Wi? HIN 180 DA YS I further expressly warrant that I comply w~th <br />the provisions of ORS 701 005 to 701 125 beeauee: <br /> <br />Elect Fee:: <br /> <br />Mech Fee <br /> <br />Plumb Fee:: <br />State <br />Surcharge (4°/°/ <br /> <br />Plans Chk Fee <br /> <br />TOTAL FEE <br />BLDG <br /> <br />) I am a registered budder OR ( ) the <br /> registered budder <br /> <br />The work will be performed <br />by a registered builder <br />Other (pleaee specify) <br /> <br />RECEIPT NO <br />Driveway <br />Permit Fee <br />Site Plan <br />Review Fee <br />Pubhc Works <br />Receipt No :: __ <br /> <br />REMARKS <br /> <br />I have read this application in its entirety and certify that the stated information ie true and correct to the best of my know/edge <br /> <br />SIGNATURE OF APPLICANT ~^ *~- _~.~. 7~-~b. <br /> PLEASE NOTE Driveway and sidewalk inspecbon are required by Pubhc Works:: 588-5036 <br /> <br />~EV ~- es Other permits required by this dept,;; Plumbing [2 Electrical [] Mechanical EJ <br /> <br /> <br />