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%~ ~ q MARION COUNTY <br />-~ -- 7/*" ~) DEPT. OF BUILDING INSPECTION <br /> <br /> T! '¢-'~ · Senator Building ~ 229 <br />Appl. Ravel: ~ . 220 High St, N.E. 2nd Floor <br />- ~ ~lem, Oregon 97301 <br />By; ..... R.H. WITHROW, BLDG. A~INIST~TOR <br /> 5~5147 - ~148 <br /> ~--22--~0 5:~ R.M .......... CODE-A-Phone ~73 ......... 8:00 A_M. <br />Date: ........... . .......... <br /> <br />Type of Perm,,; A~e~ ~ec~ -- ~ ~ ~,x ~ot No~ <br /> <br /> ~a~el T. $;ith ~o~e. / sam~ 973~5 <br /> <br />Bldr, & N0A ...... ~One; ' <br /> <br />Plans ~ Phone: ~dmss: <br /> ~ne Chg. ~arianm Fire Zone <br /> <br /> Single family <br /> <br />Lot No: <br /> <br />RIk_ No;~ Sub dy, <br /> <br />R.. <br /> <br />Occ~lDen¢¥ Type O~ Con~. <br /> <br /> ~e~ I Raar <br /> <br /> 1.41 ~'c;reao~ne¢~u ! __~ no <br />Lot Size .... <br /> <br />Water Supply: .............. Valuation: $ <br /> <br />Sewaite ~?tic Site <br />Disposal: . Evah ..... Permit Fee; <br /> <br /> No. <br />Area of $1cig; Storia~~ State 9urcharge; <br /> Roof <br />Basement: Ty~: Plahs Chk. Fee: <br />Heating Ad~quac~ Chock <br />Sys~m: ~ptic Permit Fee: <br /> <br />BTU; Total Fees: <br /> <br />VALIDATIONS: <br /> <br />Rcpt. No: <br /> <br />SEPTIC T~I~ PLANS <br />ay~ By..' <br /> <br />25.00 <br /> <br />agree to build a~eO~l/tlg tO the submitted plan= and spec/ft~tlOIl$, ~O /a~ of ~e ~ of Or~ and ~e Of;dnanCe~ oF M~/on <br />C~n~. Permit exp~e= if ~ not commenc~ wkh/n I~ da~, I fu~h~ expr~y warrant ~t I complF w~h ~e p~v/~Jon~ of ORS <br />701.~5 m 701,125 ~au~: <br /> lama~/~te~builderor( J ~eau~or/z~re~n~ti~ofar~i~bu#d~ <br /> ) The ~rk will be pefform~ by a ¢eg/~ build~ <br /> lamp~ormi~rROnap~oPe~lOwnoro~upy <br /> ) O~h~ (pl~ ~ifyJ <br /> <br />RE~ARK~: ................. <br /> <br />these are ~t ~ <br /> I have r~d th/~ apple:ion in [~ enti~ a~ ~efg/fy that ~e ~t~ in.front/on is t~e and co~ <br /> <br /> SIGNATURE OF APPLICANT, ~ <br /> PLEASE NOTE: Driw~y a~ sidewalk inspe~ions am requir~ by Public Works: ~.5036 <br /> Other permi~ r~uir~ by ~is de~: Plumbing ~ El~rl~l <br /> <br /> <br />