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Apph g%vd: ~UE$~),, y <br />By: <br />Date: 1~-2-80 <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building ~ 225 <br /> 220 High St,, N,E, 2nd Floor <br /> Salem, Oregon 97301 <br /> R.H. WITHROW, BLDG. ADMINISTRATOR <br /> 588-5147 -- 588-5148 <br />5;00 P.M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A.M. <br /> <br />Permit No. ?(~-'~c~/ ?; <br />By; / <br /> <br />Type of Permit: <br />Address: 120~J5 BJ~LDEN <br /> <br />Owner: r}E~v bELDEN <br /> <br />81dr. & No.;__ <br /> <br />ADDITION TO R~:gTt'~twn~ &-~FT!C P--~P~%'~% <br /> <br /> Phone: 7~Q-~Kg~ .. Address: <br /> Phone: Address: <br /> <br />Tax Lot No; <br /> <br />same <br /> <br />Plans by: <br /> <br />phone: Address: <br /> <br />Use Of I~la9.: ' No Sdrrnm Mi. Req. Frol~t S~ [ Rear <br /> <br />Lot NO: ,BIk. No: Sub dv, <br /> <br />Lot Size ~Corner? <br /> <br />Water Supply: ....... <br />Disposal: h <br /> <br /> No. <br />Area of 51dg: 480 ~% ¢~ Stories; <br /> Roof <br />Basement: nn Type: __ <br />Heating <br />System; <br /> <br /> 1 <br /> <br /> comp & truss <br /> <br />I~XISTt~G FORC~D &IR ELECTRIC A- <br /> <br />Valuation: <br /> <br />Permit Fee: <br /> <br />State Surcharge; <br /> <br />Plans Chk. Fee; <br /> <br />Septic Permit Fee: <br /> <br />14:400.00 <br /> 72.00 <br /> <br />BTU; Total Fees:.. <br /> Rcpt. No: <br /> <br />VALIDATIONS: <br /> <br />ZONING <br /> <br />I agree to build according to the submitted plans and spec/f/cations, the laws of the State of Ore, on and the Or/dnances of Mar/on <br />County. Permit expires if work not commenced within 120 days. / furhter expressly warrant that / comply w/th the provis/oos of ORS <br />701.OOE to 701.125 because: <br /> <br />( ) lamareglsteredbu//daror( ) theauthor/z~represen~atJveofar~/ster~bu/Ider <br />( ) The work wi//be pe~ormed by a r~istered buEder <br />( ) I am performf~g ~rk on a property I own or occupy <br />( 7 Other (p/ease ~ify) <br /> <br /> SEPTIC %1%~K. <br /> <br />I /;ave read this application in /ts entirety and certify that the stated information is true and correct to the best of my know/edge, <br /> <br />SIGNATURE OF APPLICANT: ~ ' <br />PLEASE NO]TE~ections are required by lic Works; <br />Other permits required by this dept: Plumbing <br /> <br /> <br />