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I' ' ~ j, ...~ ~ u ~ ~. OF BUILDING INSPECTION <br /> , ' .~:,/ ~ Senator Building ~ <br />App, Reed.: '~ ,1 '~U~ ~.~ ~? ~20 High St. NE_ 2nd Floor Permit <br />~ · [ ~ ~' ~. Salem, Oregon 97301 <br />~y, ~ u~ ;,~,c:, ~ C0~ ~ "~8 5147 5~ S~ ~Y: ........ <br />Date: /, / ~t ' . ...... , ..... Date: ,, <br /> <br />Bldr. & No.' ..... Phone: Address: , , <br /> <br />Plans by: ......... Phone: .,, Address: <br /> Map p~ae I Zone '" J zone Ch~;'~e pa~. J Cone. U~ J ""wla,c~Z^bl7 ... FT/FD J <br /> <br />Lot No.: ...... BIk, NOJ Sub. dy.: <br />Area of 81da, ;)nd Base~ Total <br />Main Fir.: Fir.: meat: . .Area: <br /> <br />Roof Type: ,, Trues/Stick: ..... Height:. <br />Heating Wood Water <br />System: Stove: .... Suppt,/: <br />Septic T~nk New <br />Site Eval,; ,,Jnstal.: ............. <br />Exist. No. <br />System: <br /> ! <br /> <br />VA~.IDATIONS: <br />Zoning: Mechanical: <br />Date: ..... Date:~ <br />Septic Tank: Plans: <br />Date:. ,, Pa~e: <br /> <br />I agree to build according to the aubmitted fllans and apeo/fi~etion~, the law~ of the <br />State ot Dragon end the Ordinancea of Marion County. PERMIT EXPIRES IF WORK <br />NC) T COMMENCED WITHIN ~ EO DA Y$. I further expressly warra/~t that I comply with <br />the provie/on$ Of ORS 70~,005 to 701.125 becauae! <br /> <br />( ) I am per~orming work on a property I own <br /> or o~eupy <br />( ) I am a registered builder OR ( ) the <br /> authorized repreaentatlve of a <br /> rea/orated builder <br /> <br />The work will be performed <br />by a registered builder <br />Other (please specify) <br /> <br />Occupancy,,,, J TyI~ ef Coast <br /> <br />Valuati0n; <br />Bldg. Permit <br />Fee: (+ 5%) <br /> <br />Elect. Fee:, <br /> <br />Mech, Fee: <br /> <br />Plumb. Fee: ....... <br />State <br />S~r~harge: (4%), <br /> <br />Plans Chk. Fee: <br />Septic Tank ~, <br />Permit Fee: <br /> <br />DEQ Surcharge: <br /> <br />BLDG. <br />RECEIPT NO.: <br />Driveway <br />Permit F~: .... <br />~tte Plan <br />Review Fee~ <br />PubJlc Works <br />Receipt No.: ~ <br /> <br />REMARKS: . ,, <br /> <br />SIGNATURE OF APPLICANT: -- , <br /> ///t Z~ ~---""' - ~ <br /> PLEASE NOTE: Driveway and O~fwalk inel0'ection are required by Public: WorKs; 588~5036 <br />~c ~s. 6 <br /> Other permits required by this dept.; Plumbing I~ Electrical [] Mechanical [] <br /> <br /> <br />