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. MARION 'COUNTY <br />' '- '~- ,-. ,~ ~. ii ~I~E~T~ BI~ILDI. ltLG INSPECTION <br /> ADpl. Rec~.: ~ ~High St,, N,E. 2nd Floor <br /> ~ ( ~ ~ __ ~lem, Oregon 97301 <br /> <br /> _ ~ I -- · J ~ .... ,~Hfl~ ............... CODE-A-Phone ...................... 8:00 <br /> <br />PermRNo.: <br /> <br />By; <br /> <br />Date: <br /> <br />Phone:~ Address; <br /> <br />Rub. dy_;.., I et Size: <br />~- Total <br />ment;:~ Area: <br /> <br />Root Type; . Truss/Sti~k; Height: ..... <br />Heating Wood · ~ Water <br />System: _..Jtove: ~ .~upply: <br />Septic Tank New <br />Site Eval,; IM~I.: <br />~xist. No. <br />System: .,Gals.: <br /> <br />VALIDATIONS: <br />Zoning: Meohanieah <br />Date: I ~ .., r)ate: ................... <br />Septic Tank:Date: <br /> <br />t agr~ tO bull~ a~oordlng to the subm~tad plans and s~iflcations, the la~ of the <br />State of OregOn eno the O~Ina~oee of Me,ion Count. PERMIT EXPIRES IF WORK <br />NO T COMMENCED WITHIN 1~0 DA YS. I further expr~aly werrant that / oomply with <br />the p~visions of ORS 701.0~ to 701,1~5 ~cauee: <br /> <br />I sift performing work on a property I Own <br />or occupy <br />I am a registered builder OR ( ) the <br />authorized representative of a <br />registered builder <br /> <br />( ) The work wi//be performed <br /> by a registereE builder <br />( ) Other (please. specify) <br /> <br /> Corner? .... <br /> <br />Valuation~ <br />Bldg, Permit <br />Fee; (+ <br /> <br />Type of Const. <br /> <br />Elect. Fee: <br /> <br />Mech. Fee: <br /> <br />Plumb. Fee: ...... <br />State <br />Surcharge:~{4%) <br /> <br /> Plans Chk, Fee: <br />Septic Tank <br />Permit Fee: <br /> <br />DEQ Suret~arge; <br /> <br />TOTAL FEE: <br />BLDG, <br />RECEIPT NO,: <br />Drl~way <br />Permit Fee: <br /> <br />Review F~: <br />~blic Works <br />Receipt No.: ~ <br /> <br /> ave read ~#l applleation in tie entirety and eectl~ly that ~t~ed inftormatlon is true and correct to'the ~est of my knowledge. <br /> <br /> PLEASE NOTE: Driveway and sidewalk inspection are required by Public Works: 588-5036 <br />MC 15-6 <br />~E:v 7- as Other Perm/ts required by this dept,: Plumbing [] Electrical [] Mechanical [] <br /> <br /> <br />