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MARION COUNTY
<br /> DEPT. OF BUILDING INSPECTION
<br /> Senator mui|dirtg ~2~
<br />AppL ReCcl ....... 220 Hig~ ~., N,E. 2~d Floor
<br /> ~em~ Oregon 97301
<br />By ~147 -- ~-51~
<br />
<br />Oate. ~2/Z~/~5 5.~ P M ................... CO~-A-PhO~e .................... 8.~ A.M,
<br /> ~le h~e
<br />Tyge of Pe~mit.~ ,
<br />
<br />Address' 10047 ~ ~d~ SS A~wille
<br />
<br />Owner,, Ranuy ,.,Fult ~ Phone; 399--7962
<br />md~. a No- p=iv~?e ~y ,
<br />
<br />Permit No. ~__
<br /> elec. #2366
<br /> a~**? .......
<br />
<br />Date,
<br />
<br />,, Tax Lot No .........
<br />
<br />Sec., 18 Twnshp 9 .,,~Rge. lW
<br />
<br /> Address. 137(~,, Els~e]c D~ive~ SE Sale~
<br />
<br />Address_ --
<br />
<br />Plans b,Y , Phon~ Addres,s_'
<br />60__ ~ ~P ! 85-14
<br /> NO Bdrma
<br />
<br />Ares o~ Bldg,, ~nd Ba~- Total
<br />Main Fir. Fir.. ~ me~t' .,, , A~a. ~~ VaJuation- _
<br /> ~ldg. Permit
<br /> F~: (+ 5%)
<br />
<br /> Etect Fee:
<br />
<br />Roof Type .... Truss/~tlGk. - Height'
<br />Heeling Wood Water
<br />System' - ~OYe: ....... Sup,01y.
<br />Septic Terlk New
<br />Sits Evel .... nstel.' , ,
<br />Exist 85-995 NO, 1400 gallons
<br />System ........ Gals.;
<br />
<br />VALIDATIONS.
<br />Zoning- i~ ~l*'"~, ~ ,,,'3.~- 5~.~'~'~-''-'MechaniCal:
<br />Date 1-~-~ ~ ~
<br /> · ~ .... ~ate-~ -
<br />
<br />oate".,, _'~--~;f~l /~'~'~-~ nat,: /~
<br />
<br />State ot Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK
<br />NOT COMMENC~O WITHIN 180 DA YS, I fu~h~ ez~r~My warrant tha~ I comply with
<br />the p~Ovm~on~ Of ORS 701.~ ~ 701.125
<br />
<br />( ) I em performing worg o~ a property I own
<br /> or occupy
<br />( ) / em a registered builder OR ( ) tho
<br /> authorized representative of a
<br /> registered builder
<br />
<br />( ) The wo~t{ will be I~erformsd
<br />by a reglMered buil~tor
<br />( ) Other fplease specify)
<br />
<br />Merh Fee'
<br />
<br />Plumb, Fee .,
<br />State
<br />Surcharge- (4%),, .3.00 ,
<br />
<br />Plane Chk Fee ,,,
<br />Septic Tank
<br />Permit Fee: ~ n/c: 85-995
<br />
<br />DEQ Surc;harge:
<br />
<br />TOTAL FEE' 79.. 75
<br />
<br />!~ECEtPT NO .........
<br />Driveway
<br />Permit Fee
<br />Site Plan
<br />Review Fee-. ,,
<br />PubNe Works
<br />Receipt No
<br />
<br />REMARKS
<br />
<br />I have reed thta application in its enti~jt/.y and oe~.~fy that the stated information te true a~ cor~ct to the best of my knowl~ge
<br />SIGNATURE OF APPLI~AN,:/Y ~~ ,
<br /> PLEASE NOTE Drivewr a~ and~ide~p~tion are required by Public 'Works'' 588-~36 ......
<br /> Other per.its r~uired by this dept.: Plumbing ~ E~ctrical ~ Me,bani I ~ -
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