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MARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br /> ~enator Building # 225 <br /> ~ High ~., N.;. 2nd Floor <br /> ~lem, Oregon 97301 <br /> <br /> E~E~5147 - 5~8-5148 <br /> <br />Rg,. <br /> <br />Bldr. & No.; ... Phone: ..... .. Add~: _ <br /> <br />Lot Nkk.. RIk. Ne.: ..... Sub dy., <br />Area of Bldg. 2nd BaseL Total <br />/V~in Fir, i Flr.~ ,.. merit:. Ama: <br /> <br />Roof Type, Tru~slStick. <br />He.rig Weed Water <br />System: StOve: .... Suppl¥~, <br />Septic T~nk New <br /> <br />Ex,st. No, <br />System: _ Gels. l .... <br /> <br />I ognee to bu,M accordm9 to the ~ubmitted plans ~d spec:if;ca,fans, Pne lows of the 5tote <br />Of ~9~ and t~ Ordinals of Matron Count. ~rm~ expima i~ work ~t ~m~nced <br />~th~n ~ 80 dap~ I tu~r expre~ly ~rront ~t J ~mply wJ~ ~e p~v;~n~ ~ ~S <br />701.005 ~ 701 125 ~u~: <br />( ) I ~ ~r~rming ~ ~ e p~r~ / own or ~upy <br /> <br />Lot Size C~ner? <br /> <br />Valuatt~:. <br />Bldg. Permit <br />Fee: ( + 5%), <br /> <br />Elect, F~: <br /> <br />Mech. F~. <br /> <br />Plumb. Peet .= = <br />State <br />Surehorger ..... <br /> <br />Plans Chk. Fee. <br />Seplk Tank <br />Permit l:ee. <br /> <br />) i om O regisfered builder OR [ ) the authorized <br /> represent~hve of a registered builder' <br /> <br /> DEQ Surcharge ...... ~ <br /> <br /> TOTAL FEI:~ / ~) <br /> <br />( ) The work will be performed by a cegLstored builder <br />( ) Other (please specie) <br /> <br /> 41155 8TAYT~cIO RD 8.~. <br />~IGNATU~ OF APPLICANT .~~. ~,~ ......... <br /> <br /> ~c auTE. Driveway and sld~aik ins~cflOns are r~uir~,y~rks: <br /> Other ~rmits r~uir~ by thJ~ dep~: PIumbi~ <br /> <br /> <br />