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Appl. Reed: ............... <br /> '~ ~/c,.o ~_ <br /> <br />Date: O' <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 229 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588,5147 - 585.5148 <br />5:00 P.M., ........... CODE-A-Phone 558-53?3 ........... 8:00 A.M <br /> .............. Date: <br /> <br />B~dr. & No ' <br /> <br />P ermitNo., ~._j~ <br /> ,~r <br /> <br /> Tax Lot NO: <br /> <br />Phone: __ Address: <br /> <br />Plans by; Phone: Address: <br /> <br />Lot No,; ~... .... 61k. <br /> No.:._~) .......... Sub dy <br /> <br />Area of Bldg, ')nd Base- Total <br />Main FIr.~ Fir,: merit: Area:__ <br /> <br />Roof Type; Truss/Stick~ <br />Heating Wood Water <br />System:._ Stove: ............ Supply; <br />Septic Tank New <br />Site Eval: Instal , <br />~xist. :-/U ,? (.; /'~ ~'? ~" No. <br /> <br />VALIDATIONS: <br />Zaning~ Mechanical: <br />Do t e :_ __ --._ f~-.._ .. _ _ ./~ .................. Date <br />Septic Tar~//~j,,~ [7 - Plans: <br />Date V~ Date: ....................... <br /> <br />I agree to build according to the submitted plans and spec/f/cations, the laws of the State <br />of Oregon and the Ordinances of Marion County. Permit expires if work not commenced <br />within 180 days, I further expressly warrant that I comply with the provisions of ORS <br />701,005 to 701. 125 because: <br />( ) [ am performing work on a property I own or occupy <br /> ) I am a registered builder OR ( ) the authorized <br /> representative of a registered builder <br /> <br />Bldg. Permit <br />Fee: ( + <br /> <br />Elect. Fee: ......... <br /> <br />Mech, Fee: ..................... <br /> <br />Plumb. Fee: <br />5fate <br />Surcharge: <br /> <br /> Plans Chk. Fee: <br /> Septic Tank ~ ~'~ 0 <br /> Permit Fee: <br /> <br /> DfiO Surcharg~ ....... <br /> 4'./. ~...."- .>-':~ .......... <br /> TOTAL FEE: <br /> <br /> RECEIPT NO.: ...... ~' ' ' <br />) The work will be performed by a registered builder <br />) Other (please specify) <br /> <br />, :.' .....,,, ...,,.,., ,.. ,......,......,,. ,.,':...,. ,.,....,,.o. ,,...... <br /> <br /> Other perm ts requ red by th s de t' P umb ~ ~ Electri I r -3~'~[ON' COUN T ~ <br /> p, ~ c~ tDU,LDiNG INSPECTION <br /> <br /> <br />