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II~.ARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br />~enator Building ~r225 <br />220 High ~t., N,E. 2nd FloOr <br />,,~alem. Oregon 97301 <br /> <br /> 58~-5147 -.- 588-51'~ <br /> :oo .................. ................. A.M.., <br /> <br />Plans by; L _ ~__ hone;, Address~ ~ = = - <br /> ' ~' 's~ ..... h~ <br /> <br />Lot No ,, l~lk. NO; _ Rub_ dv.:. <br />Area of I~ldg, 2nd l~ame- Total <br />Main F~t.' __ _ Fir4 rnent~ Area; ., <br /> <br />Roof Type: , _ _ . Truss/,GtiCk: -. Height:- -=.- <br /> <br />Heating Wood Water <br />System; ..... ~tove: .... BupPly: ~ <br />Septic Tank New <br />Site EvaL: ,, . Instal.: ~ <br />Exist No. <br />System: ..... Gala.: ...... <br /> <br />VALIDATIONS: <br />Zoning: Machantoal: <br />Dotal · ! ..... ...Date:_ ~., <br /> <br />I agree tO build aecordlt3g tO the submitted p/an~ a,,td spac/f/catlon& the law~ of the <br />State of Oregon atlcl the Ordtnanoes of Marion Cout~ty. PERMIT EXPIRE~ IF WORK <br />NO T COMMENCED WITHIN 180 DA Y$, I further expressly warrant that I oomply with <br />the prov$$ione of ORS 701,,~35 to 701.1~5 beoauee: <br /> <br />( ) Iarn poi'terming work on a property I own <br /> or occupy <br />( ) I am a registered builder OP ~ ) the <br /> authorize~ repl'e~entative of a <br /> <br />by a registered builder <br />Other (please specity) <br /> <br />LOt Size:-=_. Corner? <br /> <br />Vatuafion; <br />I~lclg, Permit <br />Fee: (+ 5%) <br /> <br />Eleot. Fee: - : <br /> <br />Math. Fee: . <br /> <br />F'iumb. Fee: <br />Stare <br />Sumharge: <br /> <br />Plans Chi(_ Fee: ....... <br />Septic Tank <br />Permit Fee: .. 35°00,. <br /> <br />DEQ Surcharge: <br /> <br />TOTAL FEE: ~ <br />BLDG. <br />RECEIPT NO: ~ <br />Driveway <br />Pm'mit Fee: <br />Site Plan <br />Review Fee: <br />Public: Works <br /> <br />*k/~ ~ [ R~;oipt No.: : ,, .... <br /> ; .," -: _. ....... <br /> <br /> PL ~E NOTE, ~ay a d Other ~fmits <br /> <br /> <br />