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Application for Addendum to Approved Plans <br /> Marion County Public Works b3SCI <br /> ( 5155 Silverton Rd NE, Salem, OR 973051--j ; <br /> h/ Mar unty Phone: (503) 588-5 t47 Fax: (503)588-791 g L" r- I w t- � j <br /> Email: Building(c co.marion.or.us : V , i _.,,. n" <br /> O R r CON Internet address: www.co.marion.or.us <br /> MARION COUNTY <br /> BUILDING IN-RP nTIO : <br /> An Addendum Application Cannot be Processed Without this Completed Form <br /> Original Permit Number l5- C DR FILE <br /> Site Address 7 5p G- rt G-e Lest) <br /> Any changes that increase the square footage or changes to the footprint of the structure as <br /> approved on the original permit will require a separate building permit and is outside the scope <br /> of an addendum. <br /> Revised plans are required with the changes clouded, highlighted or otherwise identified. <br /> A fee of$67.25 per hour will be charged, with a minimum of one-half hour, due at the time of <br /> application. <br /> I re.uest that the original .ermit identified above be reviewed for the following chan•e(s): <br /> # Work not specifically listed shall not be considered part of this Addendum. <br /> Use extra .a.es as needed. <br /> 1. 4 1 <br /> ■ IMINIMMEMIE <br /> ■ <br /> Signed• i �S'i�L Date: <br /> Printed contact Name: )'f(9'c`r� . S-t-yo_crcit <br /> Addre s of Contact Name: L V L. <br /> Phone Number of Contact: 5*! — Cj '7 q .-z4gE, <br /> E-mail Address of Contact: S 1= P ?j t� _ /) yakraet- CG,N/1 <br /> Office Use Only <br /> OK to accept <br /> PE initials <br /> G:\FORMS\BLDG\B-02 Addendum Submittal 01-09,08-IO,Doc <br />