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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> <br />Appl,, Revd: 220 High St, N,,E,, 2nd Floor Permit No. <br />~ Salem, Oregon 97301 <br />~" By: ~:- R,H. WITHROW, BLDG. ADMINISTRATOR By:: <br /> 588-5147 - 588-5148 <br /> /~-~-. ,;~'~_~/~.~/ 5;00 P..M.- ...........CODE-A-Phone 588-5373 ........... 8:;00 A.M <br /> Date; <br /> Date: <br /> <br />Owner :~/:~-~ <br />Plans by: Phone; Address; <br /> <br />Twnshp, __ Rge <br /> <br />Map Page ~one Zone Chg, Part,, I Cond. Use Variance Fire 2~one Occupancv Type of Const <br /> <br />Use of <br /> <br />Lot No; Blk,, No: Sub dy. <br /> <br />Water Supply: <br /> <br />Sewage ' ~ Site <br />Disposer" ~ ./~d./~ Eval;; Permit Fee: <br /> <br />Area of Bldg ~'/ ~ Stories: State Surcharge: __ <br /> Roof <br />Basement;; Type; Plans Chk. Fee:: <br />Heating <br />System:: Septic Permit Fee: <br /> <br /> Total Fees; <br /> <br /> Rcpt. No; <br /> <br />VALIDATIONS: <br />ZONING SEPTIC TANK <br /> <br /> _ Lot Size __ Corner? <br />Va u.tio.:__ <br /> <br />PLANS <br /> <br /> I a~Jree to build according to the submitted plans and speciflcat/bns, the laws of the State of Oregon and the Or/dnance5 of Mar]bn <br /> County. Permit e~p/res ff work not cotnmenced w/thin 120 days. I furhfer expressly warrant that I co~/y with the provisions of ORS <br /> 701.~5 to 701. 125 because; <br />~ I ~m a r~ster~ builder or f ) the e/J~orlzed r~re~nt~t~ve of ~ r~srer~ bur/der <br />~ The work w~71 be pe~orm~ by a r~istered builder <br />( ) I am performi~ work on a property I own or occupy <br />( ) Oth~ (please ~ec/fy) <br /> <br /> REMARKS' <br /> <br />I have read this application in /ts entiYety anti. certify that the stated information ~$ true and correct to the best of my know/edge, <br /> <br />SIGNATURE OF APPLICANT;: -~-~ ~ .... <br /> <br /> PLEASE NOTE Driveway and sidewalk inspections are required by Public Works:; 588-5036 <br /> Other permits required by this dept; Plumbing ~ Electrical ~ <br /> <br /> <br />