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MARION COUNTY <br /> DEFT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St., N.E. 2nd P~oor <br /> Salem, Oregon 97501 <br /> <br /> 58~5147 - 588-5148 <br />5:00 P.M.- .......... CODE-A-Phone 588-5375 ......... 8:GQ A.M. <br /> <br />Type of Permit: <br /> <br />Vobile i','o~e Rei)lacement ~%.-~Olcc. Connactio~ <br /> <br />Tax Lot No: ..... <br /> <br />Plans by: Phone: <br /> <br />O~e af Bldg.: N* Eldern~ <br /> j.t. ga~dcnce ,, 3 <br /> <br />Address: <br /> <br />Lot NO: _ Rik, No; ....... Sub <br /> <br />............ Lot ~lze ~.on Corner? <br /> <br />Water Supply: ~'~.] <br />~ewage Site <br /> <br /> No, <br />Area of Bld9:24 <br /> R~f <br />B~ment: ....... Ty~: ~,, <br />Heating <br />System: ...... <br /> <br />BTU: .. <br /> <br />Valuation: $ -- <br />Perm;t Fee; . .. ~,'), O0 <br /> <br />State Surch~9~: J?. 0(') <br /> <br />Plans Chk. Fee: <br /> <br />Septic Permit Fee: ~ ~Q,O0 .... ' ....: ' <br />TOtal Fees: ..... <br />..,,. No: <br /> <br />I agree mbu//d accord/ng to ~he ~ubmltted plans a~ ~if~at~n=, ~ la~ of ~ S~ of O~n end ~e Oridna~sofMw~n <br />C~n~_ Perm[t exp~es if ~rk not ~mme~ w~in 1~ da~ [ fu~ exp~/y w~t ~at I comply w/~ rhe provislofl$ of ORE <br />70L~5 to 70f. 12~ ~: <br />( ) I am a r~d builder or ( ) ~e ~orlz~ r~ntati~ of a r~l~r~ builder <br />( ) ~ ~rk will ~ p~or~ bFa e~i~ bulfd~ <br /> <br /> 0,!.'~ F, obile home is boi~: a~ , n <br />...... %~ ..:,O% O,.,.. <br /> <br />StD_ven ~_~ark= will be livinM in mobile home. <br /> <br />I have read ~h/= appllcat/on /n its entirety and certify that the stated information /S true and correct to thc best of my AllOW/edge. <br />SIGNATURE OF APPLICANT:J ;~-'/~ ....~/~ ~'~ . , , <br /> PLEASE NOTE:~a¥ a¢~:l sktewalk [nt4aectlons are required by Puro[~c Works: 588~036 <br /> Other permitS requlr~KI by this dept: Plumbing ~ Electrical <br /> <br /> <br />