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MARJOI~ 'COUNTY <br /> Yi~EPT. OF BUILDING INSPECTION <br /> <br />MARION C0UN~~ P_M ....................... COD~-A-Pho~e ................. ~ ~ A.M. Date: <br /> <br />,Rge.; ~ <br /> <br />Lot NO,';_ <br />Area of Bldg. <br />Main Fir,: <br /> <br />Roof Type; <br />Heating <br />System: <br />Septic Tank <br />Site Evel.: - . <br />Exist. <br />System; <br /> <br />VALfDATION$: <br />Zoning:: <br />Date: <br />Septic Tank: <br />{:)ate: <br /> <br />Iot Size:~ '~-:~t~C~orn r? <br /> <br />varuation:. <br />Bldg. Permit <br />Fee: (+ 5%) ...... <br /> <br />Elect. Fee: ...... <br /> <br />Me~:h, Fee~ ...... <br /> <br />Plumb. Fee <br />State <br />Surcharge: <br /> <br />Plans Chk. Fee: <br />~epttc Tank <br />Permit Fee: <br /> <br />I agree to build according to the submitted pla~l~ et)d e~eclfl~tio~ the lewe of the <br />Slate of Omgon ariel the Ordinal3oee ot Marion County. PERMIT EXPIRE$ IF WORK <br />NO T COMMENCED WITHIN 180 DA YS. I further expressly warrant that I comply with <br />the provlelons of ORS 7o~_0o5 to 7o1.I~5 b~auae: <br /> <br />f ) I am pedorming work on · propetZy I own <br /> or occupy <br />( ) I em a registered builder OR ( ) the <br /> authorized representative of a <br /> registered builder <br /> <br />REMARKS:-. <br /> <br />DEQ Surcharge: <br /> <br />TOTAL FEE: <br /> <br /> BLDG, <br /> RECEIPT NO.; <br /> /)The work will be performed Driveway <br /> by a registered builder Permit Fee: <br /> ( ) Other (pleaae spec, ity) Site Plan <br /> ~ ~ ~ Review Fee: <br /> Public Works <br />~//t'~-~" ~ ~ 'Rec ei pt NO.: <br /> <br />have read fhta spplioetion in its entry and certify tiler the stated information is true end correct to the best of my know/edge. <br /> <br /> <br />