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MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building #29§ <br /> 220 High St.. N_E_ 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> $88.5147 -- 588-5148 <br />5 oo P.M .................... CODE-A-Phone .................... ,8:00 A M, <br /> <br />Type of Permit: DRAINF~J~T~D REPAIR <br /> <br />Address 5'58? DUMORR DR ~ AUlu~J <br /> <br /> ................ Tax Lot No.: <br />,,.Sec,' 13 Twnshp.: % Rge~ <br /> <br />Owner': }4~,. ~1'~:~:t~ Phone: <br /> <br />Sldr & No.:~~ Phone: <br /> <br />Address: ~: <br /> <br />Addreas.~ 1:,o "RO"K ~,8'18 g'7~O;~ <br /> <br />Plans by ..Phone: <br /> Zone Zone Change ........ P~tt C0nd Use <br /> <br /> Use of Bldg ..... ~o sdtms <br /> ~.t~;~ , , <br /> <br />~ddress: <br /> <br />Lot No.: RIE, NO.: . Sub. <br />Area of Bldg ~nd Base- <br />Main Fir.- Fir.' ment <br /> <br />I otSl=e: ~ AC <br /> <br />Roof Typer Truss/StiCk: <br />Heating Wood Water <br />System ,Stove: Supply: <br />Septic Tank New <br />Site Eval: Instal,; <br />Exist. No <br /> <br />System __Gals.: <br /> <br />Total <br /> <br />Height: <br /> <br />VALIDATIONS <br />Zon,ng. <br />Date: ,~ <br />Septic Tan <br /> <br />Mechanical, <br />Date: ,,, <br />Plans: <br /> <br />,,, ':]ooo Sal.;Lo-s <br /> <br />Valuation:~. <br />Bldg Permit <br />Fee: (+ <br /> <br />Elect. Fee: <br /> <br />Mech Fee;~ <br /> <br />Plumb. Fee:__ <br />State <br />Surcharge (4%) <br /> <br />Plans Chk Fee: <br />Septic Tank <br />Permit Fee, <br /> <br />Corner? <br /> <br />I agree to build a;~ordlng to the submitted plans a~d specifications, the laws of the <br />~tate Of Oregon and the Ordinance~ Of Marion County. PERMIT EXPIRES iF WORK <br />NO T OOMMENCED WITHIN 180 DA ¥~. I further expressly warrant that I comply with <br />the ~)rovi$)on$ of ORS 701_005 to 701,125 because: <br /> <br />( ) I am per[ormil3g work on $ property I own <br /> or occupy <br />( ) I am a registered builder OR ( } the <br /> authorizad representative of a <br /> registered builder <br /> <br />( ) The work will be performed <br /> by a registered builder <br />( ) Other (please specify) <br /> <br />DEQ Surcharge: ........ <br /> <br />TOTAL FEE :55,OO ,, <br />BLDG. <br />RECEIPT NO.: <br />Driveway <br />Permit Fee: <br />S~ta Plan <br />Review Fee: <br />Public Works <br />Receipt No.: <br /> <br />PLEASE NOTE: Driveway and sidewalk inspection are required by <br /> <br /> <br />