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MARION COUNTY <br /> DEPT, OF BUILDING INSPECTION <br /> Senator Building <br /> 220 High St., N,E. 2nd Floor <br /> Salem, Oregon 97301 <br /> <br /> 588.5147 -- 588-5148 <br />5:00 P.M ....................... CODE-A-Phone ...................... 8:00 A.M. <br /> <br />Type of Permit: , "~e_'~~c'~e: ~<%~'['" <br />Address:_ 79.~ Poe~: Rd. ,~.. ..... <br /> <br /> ......... Tax Lot No.: .............. <br />Sec,: ._(~'~ Twnshp,: ~ Rge.~_. <br /> <br />Ow.er; ~a~, Cb'~e <br /> <br />Phone: <br /> <br />Bidr. & No.~. & 1~ Septic <br /> <br />Address: /4-'~)1 15'~3. Ave. N 97~05 _ <br /> <br />Plans by: ...... Phone: Address: <br /> <br />use OI Bldg.: I No. Bdrms. I Mi. Req. <br /> ~e~e or Ccc. Ld.: ~ SetbaCks: <br /> <br />Lot No.:~lk. No.;,, <br />Area of Bldg. 2nd <br />Main Fir.:., Fir,: <br /> <br /> .... <br /> Base- To~I <br />....... .__ment: <br /> <br />Roof Type' TrusS/Stick; .... Height: <br />Heating Wood Water <br />System: ., Stove: Supply: ..... <br />Septic Tank New <br />Site Eval.; instal.: <br />Exist, NO, <br />System; ~ea .... Gals.: <br /> <br />VALIDATIONS: <br />Zoning: Mechan;'cal: <br />Date: ........ J~ate; <br /> Tank: ~- .~ Plans: <br />Date; <br /> <br />Lot Size:~Corner?~__._ <br /> <br />Valuation' <br />Bldg. Permi~ <br />Fee; (+ 5%) <br /> <br />Elect. Fee: ,,, <br /> <br />Me~h, Fee: <br /> <br />Plumb, Fee: <br />State <br />Surcharge; (4%) _, <br /> <br />Plans Chk. Fee: <br />Septic Tank <br />Permit Fee: _ ~)~..00 <br /> <br />I agree to build according to the submitted plan~ and specifications, the laws of the <br />Stets of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK <br />NO T COMMENCED WITHIN 180 DA Y$, I further expressly warrant thai I comply with <br />the provisions ol ORS 701,005 to 701,125 because: <br /> <br />t am pedorming work on a property I own <br />or occupy <br />t am a registered builder OR ( ) the <br />author/zed ~epresentative of a <br />registered builder <br /> <br />( ) The work will be performed <br /> by · registered builder <br />( ) Other (l~lease specify) <br /> <br />DEQ Surcharge: <br /> <br />TOTAL FEE: <br />BLDG. <br />RECEIPT NO.: <br />Driveway <br />Permit Fee: <br />Site Plan <br />Review Fee: <br />Public Worl{s <br />Receipt No,: <br /> <br />REMARKS; <br /> <br />I haue reed thio application in ' ' ' <br /> t~ enhrafy and certify that the stated mfurmahon ~a true and correct to the bast ol my knowledge. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> PLEASE NOTE: Driveway &nd sidewalk inspection are required by Public WOrkS; 588-5036 <br /> <br /> Other permits required by this dept,: Plumbing m Electrical m Mechanical [~ <br /> <br /> <br />