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BUILDING <br /> <br />Property Owr'~.r <br /> <br />Jeb Addres~ <br /> <br />MARION COUNTY BUILDING iNSPECTION <br />Senator BItJg. NO,, 225 <br />220 Hige Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $884147 <br /> Code-A-Phone 4::30 PM,, - 8::00 AM. <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> Phone:: M~'¥Address <br /> <br /> Site No:: <br /> <br />S u b~d~vision <br /> <br />Mobile Homo Park <br /> <br />Saotioe Township:: <br /> <br />Range <br /> <br />Lot Width Lot Depth <br /> <br />Pro arty Tax Lot No <br /> <br />Lot <br /> <br />Sp #:: <br /> <br />Zone Map <br />Irreg Lot:: Co~ <br /> <br />I Oity Setback Requirements <br /> Reap <br /> Front ~ <br />Left ! Right <br />IS,de .%- Side <br /> <br />PERMIT APPLICATION <br /> <br /> Cross Street <br /> <br /> Fleet S/C'Zone <br /> <br />Block:: <br /> <br />Total # Spaces <br /> <br /> Cont~otor BUsiness Name and No <br /> <br />/ Architect Engineer <br /> <br />Phone <br /> <br />Phone <br /> <br />Address <br /> <br />Address <br /> <br />Type of Permit <br /> <br />Height of Building <br /> <br />Mobile Home <br />Width <br /> <br />Now [;3-~/' Addsion:: [] Demo '~ Te~h <br />Alter [] Relocation f~ Ccc Chg ~] Review <br /> <br />Sq Ft Main Floor <br /># Bedrooms <br /> <br />Occupancy <br /> <br />iMobile Home <br />Length <br /> <br />Proposed Septic Installation <br />Previous Site Evaluaeon # <br /> <br />Type of System <br />Test Holes Resdy <br /> <br />Proposed Bedrooms <br />Existing Bedrooms <br /> <br /> Will call when holes ready <br /> ~xisting Septic System <br /> __E_~_~t!rlg Tank Size <br /> Existing Drainfiold Lo~g_t_l_~ <br />__]'v_pe of System <br /> Dsfe Tank Pumped <br /> <br />Use of Building RES ~ ~ <br />Sq Ft Garage Other <br /> <br />Occupant Load <br /> Valuation <br /> <br /> Bldg Fee <br /> <br /> Mobile Home Fee <br /> Fleet Surcharge <br /> Zoning Surcharge <br /> State Surcharge <br /> Plans Cheek Fee <br /> Site Evaluabon Fee <br /> Septic, Permit Fee <br /> DEQ Surcharge:: <br /> Technical Review Fee <br /> Reinspection Fee <br /> Investigation Foe <br /> City, f=ee <br /> T~%AL FEE <br /> <br /> RECEIPT NO <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING. MECHANICAL. ELECTRICAL <br />MC' ~5,6 <br /> <br />1o ?g <br /> <br />,:7¢¢o <br /> <br /> <br />