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MARION COUNTY <br /> ./; //1 . DEPT. OF BUILDING INSPECTION <br /> <br />Appl. <br /> Revd:; <br /> :220 High St., N.E. 2nd Floor <br />  Salem, Oregon 97301 <br />By: (- R.H. WITHROW, BLDG. ADMINISTRATOR <br /> 588-5147 - 588-5148 <br /> /,~ _/~_./'"'~-/ 5;:00 P.M.- ...........CODE-A-Phone 5B8-5375 ........... 8::00 A,M, <br />Date;; <br /> <br />Permit No. <br /> <br />By;; <br /> <br />Type of Permit:: ~'~0& i~-[/~.~¢J -- ~¢~ ~g<~r'~--" ~"~' TaxLotNo. <br /> <br />Owner: -- Phone;: <br /> ........ ~ · <br />Bldr, ~ ~.; <br /> <br />Plan Phone: Address: <br />Map Page Zo.e ~ Zone Chg ~rt: Cond, U. Variance Fi~e Zone Occupancy I Type of Const, <br /> I <br /> <br />Lot No:: , BIk, No;; Sub dv. Lot Size Corner? <br /> <br />Water Supply:: Valuation; $,,, <br />Sewage Site <br />Disposal:: Evah Permit Fee;. <br /> No. <br />Area of Bldg;~/oc~ c,~ ~ Stories;~ ~ State Surcharge; <br /> <br />Basement; ~ Type: ~ - ~ ~ Plans Chk. Fee; /~, ~ ~: ..... <br />Heating <br />System: Septic Permit Fee; <br /> <br />BTU;; Total Fees; ~,~. ~)~c:~-"'~ <br /> <br />Rcpt. No: <br /> <br />VALIDATIONS;; <br />ZONING SEPTIC TANK PLANS ~ <br /> <br />/ aEree to build accordi/~j to the submitted plans and spec/f/cations, the law~ of the State of Oregon end the Oridnances of Marion <br />County. Permit expikes if work not commenced within 120 days. I furhter expressly warrant that I comply with the prow$ib~7$ of ORS <br />7~ 0~15 to 701.125 because;' <br /> am a registered builder or ( ) the authorized representative of a registered builder <br />( ) The work will be performed by a registered builder <br /> <br />( ) Other (please ~pecify) <br /> <br />REMARKS, <br /> <br />have read this applicat)bn )~ its entirety and certify that the stated information i~ true and correct to the best of my know/edge <br />SIGNATUR~ OF APPLICANT;: ~' I~ <br /> PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works; 688-5036 <br /> Other permits required by this dept;; Plumbing [] Electrical [] <br /> <br /> <br />