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FRIDAY <br />'~ ppk.R e'vd'. <br /> · PJN <br />8¥: '_ · ' ~ <br /> <br />Date; <br /> <br />Type of Permit; <br /> <br />DEPT. OF BUILDING INSPECTION <br />Senator.Building # 225 <br />220,High ~,, N.E: 2nd Floor <br /> Salem, Oregon 97301 <br />R,H, WITHROW, BLDG. ADMINISTRATOR <br />588,5147 588-5148 <br /> <br />SITE EVALU,i. TION ONLY <br /> <br />Tax Lot No: __ <br /> <br />Address;_.?,l, la0 Aums~ille ~ " '? .. Sec PCd~/5.'~-Twnshp, 0 50_.Rge. ~ d. <br /> ~...O,~-, S~ 0~o~ ~7~0] ......... <br /> ~f: ,~el ~02, Page 199~ ~K~°~ ~u~ty :~co~ds <br />Owner: {ilLia~,,~,. ~ M~rEaret ~. ___ ~¢ne 378-19~0 ...... Address:_~a~e as abo~e <br /> <br />Bldr. & No,: <br />Plans by: <br /> <br />........................... Phone: <br /> <br />zone o,5` [ ~o~e Oho, <br />AR _% <br /> <br />Address; <br /> <br /> Phone: ] ,/o.~:~_~3 %hs~d d r ess; <br />~ear t. T--' Co nd. (J~"r iai1 ce Fire S~e <br />...... ~,1o B~d%~;~-~- Min Boq. Front <br />or Oct. Ld~ Setbacks'. <br /> <br /> 1 thru 3.1 2 <br />Lot No:~. J-..~3- J~; ~ BIk. No: .. 1 <br /> <br />Water Supply: l'nd~ t~ff ,']1~1...~J~] ] ~ <br /> <br />Sewage Site <br /> <br /> No, <br /> Areaof Bldg; __ Stories:_. <br /> Roof <br /> <br />Heating <br />Svstem; <br /> <br />BTU; ....... <br /> <br />tlr' S. E ..,_. SAL~"~t, Ore. ...... <br /> <br />Sides I Rear <br /> <br />mn-my r r,'a ;,'q,L,A?~ (io~EL~yLot S,ze~ .Aet'e-s Corner? ()t.) wgL'I~ be <br />Filbert Park)ii~rd copy pending (See,~.~:,~l~,~.r~f,~ sketch, att'd) <br />._ Valuation: _. <br /> <br />Permit Fee: ...... -- <br />State Surcharge: <br /> <br />Plans Chk. Fee; <br /> SiTE ,~VALUATION 562.50 <br />Septic Permit Fee: <br /> <br />Total Fees: <br />R cpi. No: ~-..,~--. -~--~ <br /> <br />I agree to build according to the submitted plans and apeofica,/o~r~the law~ of the Stare of Oregon and the Ordinances of Mar/on <br />County. Permit expire~ i/work not commenced within 120 days. //~ <br />SIGNATURE OF APPLICANT; - ,,. ¢ ,~. <br /> <br /> REMARKS <br /> <br />PLEASE NOTE; Driveway and sldewalk inspections are required by Public Works; 588-5036 <br />Other permits required by this dept: Plumbing f~ Electrica( ~-] <br /> <br /> <br />