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ApDI, ~Revd: . r~ <br /> <br />Date: .... /2'+~ 7., <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Downtown Senator Building <br /> 210 H~gh St., N.E. 3nd Floor <br /> ~alem, Oregon 97301 <br />R.h. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 -- 58~.5148 <br /> <br />Type of Permk; ,. <br /> <br /> L o . j/ <br />Address: <br /> <br />81dr, R No.: J.,c ~i~ Phone: <br /> ....... <br /> <br /> Tax Lot No: .... <br /> <br /> est <br />Addre~:__ <br /> <br /> Address: <br /> <br /> ! <br />Lot No;. .BIk, NO: _ ~ub dy. ~ ~ . ~re SCorner? <br /> <br />Water SUp~y: · ,,e~ l , ,,. Valuation; , $ .:.C,~C0. <br /> <br />~wage ,,,e t3 c Fea~ l~+~ .~0 <br />Di~l~ Study: 1-77-~,1 Permit FeB; <br /> <br /> No. ~ <br />Ama of Bldg: 1500 S~ries: " StateSur~ar~: ,, %~- <br /> <br />~m~t: .~ r~o Ty~: - Plans ChK, Fee: ~ ,. - ...... <br /> <br />~atl~ ~[ 37.50 <br />Sy;mm; _. Septic Permit Fee: <br /> <br />BTU: ..... Total Fees: .................... <br /> <br />VA LI~j~T4~ ~ <br />ZONtNG~)a~ <br /> t <br /> <br />SIGNATURE OF APPLICANT' /~"~'~ ///, /4 .~-~! , <br /> <br />REMARKS <br /> <br />PLEASE NOTE: DrlveW~,y e~cl sidewalk ;nspections are required by Public Works; 588~5036 <br />C~het laermJt~ require~ by th;s dept: Plumbing I~1 Ele~rical [] <br /> <br /> <br />