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MARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br />Senator Building # 225 <br />220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588-5148 <br /> <br />Permit No. <br /> <br />Date: ,~- _~ _~.7,.~ 5:00 P.M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A.M. Date; <br /> <br />Bldr, & No.: ...... Phone: <br /> <br />Plans by: Phone: <br />Map Page~,~Z°ne " Zone Chg, pert. ' Cond. U~ <br /> <br />U~ of Bldg.: No Bdrm~, <br /> or Occ. Ld; <br /> <br /> Address: . <br /> <br /> Address: <br />t Variance <br /> I Fire Zone <br /> <br />Lot No: BIk. No: .... Sub dv. <br /> <br />Water Supply; <br /> <br />Sewage <br />Disposal: <br /> <br />Site <br />Eval: <br />No. <br />Stories; <br /> <br />Roof <br />Type: <br /> <br />Twnshp. __Rge. <br /> <br />Front Bides ' Rear <br /> <br />State Surcharge: , ,. <br /> <br />Septic Permit Fee: <br />TotaJ Fees: / ~"~ ~ <br /> <br />Area of Bldg: <br /> <br />Basement: <br /> <br />Heating <br />System: <br /> <br />BTU: <br /> <br /> VALIDATIONS; <br /> ZONING SEPTIC TANK PLANS <br /> By: By: <br /> <br />/ agree to build accord/nE to the submitted plans and spec/flcatJons, the laws of the State of Oregon and the Oridnance$ of Marion <br />County. Permit expires if work not commenced within 120 days, I furhtar expressly warrant that / comply w/th the provisions of ORS <br />701.005 to 701.125 because: <br /> <br />( ) lamaregisteredbui/deror{ ) theauthorizedrepreaeotetiveofaregisteredbui/der <br />( ) The work w//Ibeperformedbyaregisteredbuilder <br />~ ) I am performing work on a property I own or occupy <br /> ( ) Other (please specify) <br /> REMARKS: <br /> <br />/ have read th/~ application in its entirety and certify that the stated information /s tree and correct to the best of my know/edge, <br /> <br />SIGNATURE OF APPLICANT: <br />PLEASE NOTE: Driveway and sidewalk inspectior~_..~re required by Public Works: 588-5036 <br />Other permits required by this dept: Plumbing [] Electrical [] <br /> <br /> <br />