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By: <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 /> <br /> 588-5147 - 588-5148 <br /> <br />Date:: 5::00 P,,M,,- ........... COC)E-A.Phone 588-5373 ........... 8::00 A.M, <br /> Date~ <br /> <br />Owner: ,5~i'~A~ ~ ~ ~ Phone:~ Address: <br /> <br />81dr. & No,;: Phone: Addces$: <br /> <br />Plans by:: Phone: Address; <br /> <br /> MaD Page Zone Zone Chg Part Cond, Use[ Variance t FiroZone I Occupancy [ TypeofConst <br /> <br />Use of Bldg :: No Bdrmt. 'Min Req. Front [ Sides Rear <br /> <br />Lot No.~ SIk, No.: Sub dy. <br />Area of Bldg. 2nd Base- Total <br />Main FIr,: Fir.: ment: Area: <br /> <br />Roof Type:: Truss/Stick: <br />Heating Wood <br />System: Stove: <br />Septic Tank New <br />Site Eval:: ....... Instal . <br />Ex~sf No, <br /> <br /> Water <br />., Supply:. <br /> <br />Lot Size__Corner? <br /> <br />Valuation:,, , <br />Bldg,, Permit <br />Fee:: ( q- 5%)_ <br /> <br />Elect. Fee: <br /> <br />Mech, Fee=. <br /> <br />System= Gals . __ Plumb, Fee: <br /> State <br />VALIDATIONS, Surcharge:. <br />Zoning~ Mechanical: <br />Date:: .... -/~.._/ Date~ Plans Chk. Fee~ <br />Septic Tankl~/,~ ,~ Plans: Septic Tank <br />Date~ l~,~! --~,7-':'~ Date. Permit Fee. <br /> <br />I agree to budd according to the submitted plans and specifications, the laws of the State DEQ Surcharge- .~' <br />of Oregon and the Ordinances of Mar~on County. Permit expires if work not commenced <br />within 180 days, I further expressly warrant that I comply with the provisions of ORS TOTAL FEE~ / ~ <br />701005 to 701 12.5 because: <br />( )'amperformingworkonaproperh/lownoroccupy RECEIPTNO,~ ---~/~'" <br />( ) t am a registered builder OR ( ) the authorized ( ) The work will be performed by a registered builder <br /> representohve of a registered builder ( ) Other (please specify) <br /> <br />SIGNATURE OF APP[_ICAN~ ..... ~¢~ ~,~ ~4, O~ ~" <br /> PLEASE NOTE Driveway and sidewalk inspections are requir~,y~rks;: 888-5036 <br /> Other permits required by this dept;: Plumbing ~ Electrical ~ <br /> <br /> <br />