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Appl. <br /> <br />By; PiP <br /> <br />Date;i" -/;.- ? <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION' <br /> Downtown Senator Building <br /> 220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br />R.i~. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 - 588-5148 <br /> <br />Bldr. & NO.: Phone: Address: <br /> <br />Plans by: Phone; <br />Use O{ Bldg.; <br /> <br />Lot NO: .......... Blk, NO: Sub dy. <br /> <br />Sewage ~ .... iiTM- . ~ Feas. <br />Disposal: ~ Studg: <br />Area of Bldg: / ¢~ ~kStories;NO' / <br /> T~pe; · <br />Heating ~./&~ <br />System; <br /> <br /> Address: <br /> <br />Min Req. Front Sides T Rear -- <br /> 1 <br /> <br /> Lot Size 6~ ',c,r~2 R Comer? . <br /> <br />Valuation: __ <br /> <br />Permit Fee: ..... <br /> <br /> 1 ./:.0 <br />State Surcharge; <br /> <br />Plains Chk. Fee: <br /> <br />Septic Permit Fee: <br /> <br />BTU: Total Fees: <br /> <br />I agree ~o build according to the submitted plans and ~pecif/cations, the laws of the State of Oregon and the Ordinances of Marion <br />County. Permit expires/f work not c~)mmenced within )120 days. <br />SIGNATURE OF APPLICANT: /~ ~,~/'~-,~,' G~ <br /> <br />ZONI~L~~ SEP j~ PLANS <br />By,, ~j~c~ ~y; //.?~/~'_ AIcT"~-,--~--"~"~'k <br /> <br /> REMARKS <br /> <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works; <br /> <br /> Other permits required by this dept: Plumbing ~] ElectricaJ [] <br /> <br /> <br />