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I2-26-86 <br /> <br />No. <br /> <br />Address: <br /> <br />Plana by: <br /> <br /> _[ <br /> <br />LolNO_:, ~ ~ <br />Main Fir.' ..... <br /> <br />Root Type'. · . . TruaeJStiok:~ Neight~ , <br />Heatmg Wood water <br />System __ , ,~tove: ,., Rupply: . <br /> <br />S~te Eval.: .... Ina~L: ., <br />System: ....... Gals .... <br /> <br />Tt~ work wi//be performed <br />by m regl~te.~ bullOer <br />Other ( ple~,e spee~fy ] <br /> <br />VALIDATIONS. <br />Zoning- Mechanical <br />Date faire: <br />Sepbc <br /> Tank: <br />Date .... Oate,~ ~ ~ ~ -.. <br /> ~ ._. <br />I a~ lO bu#d ecc~d~ to t~ su~in~ ~nS mod ~p~ifloaOoo~ t~/a~ of t~ <br />~tete o~ Oregon l~ t~ Ofdi~ Of Ma~ Coon~. PERMIT EXPIRE8 IF WORK <br />NOT COMMENCED WITHIN 1~ DA YS. I fu~her expma~y warrant that I c~ply w~th <br />the p~v)~lOn= of 0~3 701 ~ to 701 I~5 ~u~: <br /> <br /> ~ ) I am ~rformt~ w~k ~ a p~y I own { <br /> or ~cupy <br /> <br /> auth~l;~ ~p~tatJ~ el a <br /> ~glster~ boiler <br /> <br />Elect. Fee: <br /> <br />Mech Fee ~ <br /> <br />Fqumb Fee: ,, <br /> <br />stale <br />SurCharge ~4%! //*' t'~/') <br />,,.. .... i6.45 <br /> <br />BLDG <br />~E~Ei~ NO ,, <br /> <br />Site Plan <br />R~ F~ ..... <br />~bflc Wo~ <br />~eoelpt No: <br /> <br />REMARKS; <br /> <br />I beve read th~s aopllcatmn/n its entirety and certify tiler the slated reformation ia true end ~orfeot to tile beat o! my knowled~ <br /> <br /> <br />