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Appl, Recd~ '~L'_. <br />BY: P,~'±'iY __ <br />Date:: 4~2~- 8 ~ <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St., N,E. 2nd Floor <br /> Selem, OregOn 97301 <br /> <br /> 588-5147 -- 58~5148 <br />P.M,- ........... CODE-A-Phone ~8.~373 ........... 8:00 <br /> <br />Type of Permit: <br /> <br />Address:__].~103 ~.,~Y R9 ,i,~ :, UIORA 97~02 <br /> <br />Owner: jA[,!g S ~:[TCK£L Phone;, 678-5784 <br /> <br />..... Tax Lot NO:: <br />Add rest;: ~L~ <br /> <br />81dr, & No.: SELF Phone: <br /> <br />Address: <br /> <br />Plans by: <br /> <br /> F ~;',':i LY [~ <br /> <br /> Phone: Address: <br /> 'l --"cond, Use J ' <br />Zone Chg, Peet. ' Variam~ '" <br /> <br />TVoe of Cor~'~, <br /> <br /> .~ J <br /> <br />Lot No,. BJk. No_:__ Sub dy. <br />Area of 8ldg_ 2nd Base- Total <br />Main Fir.:, ,,,,. Fir,: ,, menh Area, ,192 ,~ ~t <br /> <br />Roof Type;: CV~,"P .... .... Truss/Stick:, STi :1,:, <br />Heating Wood <br />System %~I~T Stove;__.~ !<C~ , Supply.' '~'*~LL <br />Septic Tank New <br /> <br />Septic Tank: <br />Dote~ <br /> <br />Mechonlcah <br />DOte;_ <br /> <br />Plans~ <br /> <br />tot Size20,~xz©8 Corner?_ <br /> <br />Valuation: <br />Bldg. Permit <br />~: ( + ~%) 3.i~,~. <br /> <br />~,lect_ Fee: , ?0.00. ......... <br /> <br />Mech, Fee: <br /> <br />Plumb. Fee: <br />State <br /> <br />Plans Chk, Fee~ ? ~-] 7 <br />Septic Tank <br />PermitFee:. <br /> <br />I agree to build ae¢ording to the subrnitteW plans and specifications, ~e Jaw~ of t~ Sto~ DEQ Surc~rge: ....... <br />~ Oregon and the Ordinances of Mar/on County Permit expires if work not commen~d <br /> 180 <br /> I <br /> further <br />701.005 to 701 ,, 125 <br />C ) I am ~rformtng work on a property I own or occupy RECEIPT NO.~ <br />( )l~mo~g~redbu~lderOR( )fheauthori~ed ( ]rhewor~llbe~rformedbya~g~s~redbugder <br /> represen~n~ of a regls~red builder ( ~ Other (please spedfy) <br /> <br />SIGNATURE OF APPLICAN <br />PLEASE N~riveway a~ sidewalk ins~ctlons are required by Public Works: 588-60S6 <br />Other pecmlts required by this dept:: Plumbing ~ Electrical <br /> <br /> <br />