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Recd.: <br />Chr~ e <br /> <br />Oate: 8-10-86 <br /> <br /> MARION COUNTY <br /> DEPT, OF BUILDING INSPECTION <br /> Senator Building #225 <br /> 220 High St.. N.E. 2nd F~oor <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 -- 588-5148 <br />5:00 P.M ....................... CODE-A-Phone ...................... 8:00 A,M, <br /> <br />Permit No.: <br /> <br />By; LTF',AN~3 TT~ <br />Date: 8-27-86 <br /> <br />Type of Permit: Existing ayetem eW~luation f~r loan purpoSeSTax Lot No.:, <br /> 11041 A~n~'~Kd. N~ <br />Address: Polzel~ L~,enc, e J. & Verna E. Sec.: 32 Twnshp.: <br /> <br />3 Rge,: lw <br /> <br />Owner: <br /> <br />BJdr. & NO.: <br /> <br />Plans by: <br /> <br /> ~hone: 678. 5015 <br /> <br />~t~n W Ohm mhone: ~&5-~52 Address\~"~.O. 475 331~¢~:~:tD( ~0r 97062 <br />Agent- Art Lutz Realty <br /> .PhOn~;~ddress: <br /> <br /> MaP Page I Zone l, ZoneChange I Part. I Cond, Use Variance/Adj. FT/Fe Occupancy J Type of Const. <br /> <br />use o, a,dg.: I NO, edrms, ~ Mln Req, FrontI S,des ~ear <br /> ~eS. or Oct. Ld.: 3 Setbacks: <br /> <br />Lot No,: BIk, No.:___,~ub, dy,: __Lot Size: <br />Area of Bldg. 2nd Base- Total <br />Main Fir.: Fir,: merit: Area: <br /> <br />Roof Type: Truss/Stick: Height: <br />Heating Wood Water <br />System: ~tove: _Supply: ~el/, <br />Septic Tank New <br />Site Eval.: .Instal,: <br />Exist. No. <br />System: ye. ..... Gals.: ........ ~ <br /> <br />VALIDATIONS: <br />Zoning: Mechanical: <br />Date: ~ I <br /> Plans; <br />Date: ?F_I Date: __ <br /> <br />Valuation: <br />Bldg. Permit <br />Fee: (+ 5%) <br /> <br />Elect, Fee: __ <br /> <br />Mech. Fee: <br /> <br />Plumb, Fee: <br />State <br />Surcharge: (4%) <br /> <br />Plans Chk. Fee: <br />Septic Tank <br /> <br />Permit Fee: <br /> <br />I agree to build according to the submitted plans and specificaticna, the laws Of the <br />State of Oregon and the Ordinances cf Marion County, PERMIT EXPIRES IF WORK <br />NOT COMMENCED WITHIN 180 DA YS, I further expressly warrant that I comply with <br />the provisions of ORS 701.005 to 701.125 because: <br /> <br />( ) I am performing work on a property I own <br /> or occupy <br />( ) I am a registered builder OR ( ) the <br /> authorized representative of a <br /> registered builder <br /> <br />( ) The work will be performed <br /> by a registered builder <br />( ) Other (please specify) <br /> <br />DEQ Surcharge: <br /> <br />TOTAL FEE: 60°00 <br /> <br />RECEIPT NO.: <br />Driveway <br />Permit Fee: <br />Site Plan <br />Review Fee; <br />Public Works <br />Receipt No.: .... <br /> <br />I have read thi~ application in it, entirety and certi~ ~t~ ~tated information i~ true and correct to the best <br />SIGNATURE OF APPLICANT~ ~ ~~~ <br /> PLEASE NOTE: Driveway and sidewalk inspection are required by Public Works: 588~5036 <br /> <br />of my know/edge. <br /> <br /> <br />