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TUE~¥
<br />
<br />By:,,
<br />
<br />Type of leermit:
<br />
<br />Address:
<br />
<br /> MARION COUNTY
<br /> DEPT. OF BUILDING INSPECt*ION
<br /> Se~l:~tor Ruildin9 ~225
<br /> 220 High St., N,E, 2nd I;toor
<br /> Salem. Oregon 97301
<br />
<br /> S88-$147 -- 68~-~14a
<br />5:00 P.M ....................... CODE-A-Phone ...................... 8:00 A.M,
<br />
<br />204 E~TL~4
<br />
<br />Tax Lot NO,:--
<br />
<br />Sec.: .__--Twtlshp,: ..
<br />
<br /> JO~N PFA~T 838-1~54
<br />Owner: Phohe: ....... Address:
<br />
<br /> Rge.; .......
<br />
<br />20 SOUT~ FOURTH I'RDEPk~DENCI
<br />
<br />Btdr, & No.; Phone:, Address:_
<br />
<br />Plane by: Phone: Addcess:
<br />I
<br />
<br />Lot NO.; RIk. No,; .~iob. dY.:
<br />Area of Bldg. 2nd Base- Total
<br />Main Fir,: .Fir.: ,,, ment:__ .-.AreA:
<br />
<br />I bt Size:, Corner?_
<br />
<br /> Valuation: .....
<br /> Bldg. Permit
<br />Roof Type:, TruS.~/Stick::__ Helghtt Fee: (+ 5%} ,
<br />Heating Wood Water
<br />System: . ,Stove: Supply: Elect. Fee:
<br />Septic Tank New
<br />Site Eval.: ..... instal.: , Mech. Fee' .,,
<br />Exist, No.
<br />System: ., Gals.: Plumb. Fee: ....
<br /> State
<br />VALIDATIONS: Surcharge: ,, (4%~ ,
<br />Zoning: Meohanl~al~
<br />Date; rSate: Plans Chk. Fee: , 'tOe(X)
<br />Septic .... Tank: Plans:. ,W~,_,A~.,.. ~ ,,,~ , _~.,.. ~,~ Septic Tank
<br />0ate; Date:-,--,'-'-- Permit Fee:
<br />
<br />I agree to b~lld according to the submitted plar~s and specifications, the laws of the
<br />State of Oregon and the Ordinances of Marion County, PERMIT EXPIRES IF WORK
<br />NOT COMMENCED WITHIN 180 DAYS. I further expressly warrant that I comply with
<br />the provisions o/ORS 701,005 to 701.125 because:
<br />
<br />( ) The work will be performed
<br /> by a registered builder
<br />( ) Other (please specify)
<br />
<br />( ) I am performing WOrk on a property I owo
<br /> or occupy
<br />( ) I am a registered builder OR ( ) the
<br /> aut/iorized representative of a
<br /> registered builder
<br />
<br />DEQ Surcharge:
<br />
<br />TOTAL FEE:
<br />BLDG.
<br />RECEIPT NO,;
<br />Oriveway
<br />Permit Fee: ....
<br />Site Plan
<br />Review Fee: ............
<br />~ubllo Works
<br />Re,slot NO,: _
<br />
<br />10~00
<br />
<br /> 3532
<br />
<br />REMARKS:_,,
<br />
<br />I have reed trna e~)plloel/on In/ts enttrety~rtify that the stated information is true and correct to the Oeat of my ~nowl~ge.
<br />
<br />SIGNATURE OF APPLICANT: _. z'"A~'-~*'r( ~
<br /> PLEASE NOTE: Drive~f'ay" and si~ew~ in,~e~'tion ate required by Public Work~'; ' 588-5036
<br /> Other permits required by this dept.: Plumbing t~ Electrical ~ MeohaniOal C]
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