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/? <br /> <br />. Job Address <br /> <br />Race,veal By 7' ~ ~\ ~ ~ MC~BI~/Nf~O~TY BUILDING INSPECTION <br /> <br />Zoning Validatio, ~-~--l&~ ¥" ~'O "1," 8.r~ NE <br /> ~ , ~ M ~ ~ ¢ ....... ' ~lem, Oregon 97301 <br /> <br /> Site No <br /> <br />City Setback Requiremeota <br /> <br /> / <br />Front '~0 z ! Rear ,/¢ / <br />Left ~';ghi .......... ~/- .... <br />Side:: _~ ! J Side 5 <br /> <br />PERMIT APPLICATION <br /> <br /> Cro~ss Street:; <br />Property Tax Lot NO :: Fleet S/O Zone:: <br />LOt Block <br /> <br />Mobile Home Park Sp # Total # Spaces:; <br /> Zone:: Map <br /> <br />Lot Width <br /> <br />Township.i/~1~ <br /> <br />Irreg L~/ <br /> <br />L~0~)'~' Oo_ntraotor Business~)plcN~.~e~j~and NO ~i.~ ~.~.~ <br />Architect fEngineer Phone <br /> <br />Addresa:: <br /> <br />e of Permit;; [ New ~ Addition [] Demo:: [] Tach <br /> ~'~'~" i Alter [] Relocation [] Occ Ch9:: [] Review [] <br /> <br />Uae of Building:: <br /> <br />RES <br /> <br />COM ~ <br /> <br />Height of Building No So, es Sq Ft Main Floor Sq Ft 2nd Floor:: Sq Ft Garage Other:: <br /> <br />Mobile Home Mobile Home # Bedro getup Occupant Load <br />Width:: Length -- I <br /> <br />Proposed Septic Installation <br />Previoua Site Evaluation #:: <br /> <br />Type of System:: <br /> <br />Test Holes Re~dy:~ <br />Will call when holes ready Proposed Bedroom~ <br />Existing Septic System' <br />Existln9 Tank Size <br />Existing Drainfield Length <br />Type .of System <br /> <br /> Bedrooms <br /> <br />) The work ¢dll be performed by ~ registered builder <br /> <br /> ) Other <br /> I ¢xgree to build acc u <br /> the state of Crag an <br />SIGNATURE OF APPUi~ <br />McOTHER~s-6 PERMITS RE~ <br />Rev 12,87 <br /> <br /> e submitte pecificat' a the lawsof <br /> <br />BY THIO DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Valuation <br />Fee $ <br /> <br /> Fleet Surcharge <br /> <br /> ~.~on,no Surcharge:: <br />~ Y6 Surcharge <br /> <br /> Plans Check Fee <br /> <br /> DEQ Surcharge:: <br /> <br /> Teohnio~l Review Fee <br /> <br /> Investigation Fee <br /> City Fee <br /> <br /> TOTAL ~EE <br /> RECEIPT NO <br /> <br /> <br />