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Appl. Recd'-
<br />
<br />BW C' : '7'.'..
<br />Date! '!,'~'-:~ %~!~
<br />
<br /> MARION COUNTY
<br />DEPT. OF BUILDING INSPECTION
<br />Sanat, Or Building # 225
<br />~20 High St., N.E. 2nd Ftoor
<br /> Salem, Oregon g7301
<br />
<br /> 588-5147 -- 588-514B
<br />5:00 P.M.- ........... CODE,A-Phone 568-5373 .......... 8:00
<br />
<br />Type of Permit:
<br />
<br /> n,/~r,~ ~,-~,'r,,,,, ~,, ;,,,) ~,~
<br />
<br /> ......... . r.:~."... ~ n.~_~o~
<br />$1dr. & No.; "'~"~ ....... ~ "-' ~ '~ ',"::
<br /> := / ~hone'-""~=~'~
<br />
<br />.Plans by: ~hone:
<br />~,",, ' ~,o ~"". / '~""- .] co-.. u.
<br />
<br />Lot No-: BIk. No ' Sub dy.
<br />Area of Bldg. 2nd laase-
<br />Main FIr,~ ........... fir,. ment'
<br />
<br />Roof Type: ~ Truss / ,~tick:
<br />Heofincj Wood Water
<br />
<br /> permit
<br />
<br />,,Date;
<br />
<br />.... Tax Lot NO; - ' -,
<br />
<br />Address: ?.) :.~OY~ ~c),';: ~
<br />
<br /> v., ~,... Fire Zone J ~ccupanc~ t ,,,Typ~"g~ ~.OngL
<br />
<br />Total
<br />
<br /> ~a. Eermit
<br />
<br />System; .............. 5toYe~ ,. Supply~ ~
<br />Septic Tank New
<br />Site EvOI: Instal, '
<br />~xi~t.
<br />Sys~ern~ Gal~.,
<br />
<br />~ect. Fee: ] ~L.,-,-,-,-,-,-,-,-~
<br />Mw;h, Fee: i, ;~ :'
<br />
<br />~l~mb, I~ee= ......
<br />Stat~
<br />
<br />~ns Chk. Fee;
<br />~ptic T~nk
<br />
<br />Surcharge;
<br />FEE:
<br />
<br />~he work will be per~rmed by ¢~ registered huilde[
<br />Other (please
<br />
<br />VALIDATIONS:
<br />
<br />Septic Tank
<br /> Da~ .....
<br />
<br />I ogr~ to build ~d~ng fo the submittal plans and specifications, ~e laws of ~e
<br />0f ~ and ~ Ordinals of Marion Count. ~ermit expi~s if Wo~ nat comme~
<br />~in 180 da~, I further expre~ty warrant that ] ~mply with ~e provisions
<br />701,005 to 701.125 ~u~:
<br />( ) I am ~rmlng work on a property I Own er ~upy
<br /> ) I am o ~egis~r~ builde~ OR ( ) ~e ou~orlzed
<br /> representative of a mgls~red bullder
<br />
<br />REMARKS:
<br />
<br />PLEASE NOTE; Driveway a~ sid~alk inspeetion~ are required by Public Works; ~-50~
<br />Other ~rmits r~uir~ bY this de~: Plumbing ~ El~trical ~
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