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Th~6~ay <br />AppL Revd; ,,, <br /> <br /> i.!~da and dottle <br /> <br /> MAI41UN I~UUi~ I I <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Buildir~ # 225 <br /> 2213 High St.. N,E. 2nd Floor' <br /> Salem. Oregon 97301 <br /> R.H. WII'HROW, BLPG. ADMINISTRATOR <br /> 588-5147 -- 5855148 <br />P.M.-- ..... CODE-A-Phone 588-5373-----8:00 A,M. <br /> <br />TVpe of Pemmit: $~r~e sh~d / ho~m3p~e ,,shop / <br /> 9948 5~ayt~ Rd ~.E. A~svi~le 97325 <br />~dr~: , , call CO ll~t <br />~er: Ne%,% ,piC~ Phone~ <br /> <br />Permit No. F~--/~ ~_ <br />By: Z~ <br /> <br /> ,Tax Lot No; .... <br />,,, <br /> <br />Bfdr,, & No.: ....... ~hone: <br />Plans by: Phon~. <br /> 1 , , <br /> <br />Lot Ne: <br /> <br /> well <br />Water Supply: .............. <br />Sewage s~ptic t~Y~ :5~te <br />Disposal; ...... ' , <br /> 2OX30 No, <br />Area of <br /> Roof <br />ISasement: ......... Type: m~~-~ [ <br />Heating <br />System: ......... <br /> <br />BTU: ,,. <br /> <br /> Lot Size 16~ 37 . <br /> 4~00,00 <br />Valuation; ,~ <br /> <br /> 32.00 <br />Permit Fee; ,,, <br /> <br /> 1.28 <br />$~te Surcharge: .... <br /> <br /> 8.00 <br />Plans Chk. Fee; <br /> <br /> no <br />Corner7 .. <br /> <br /> Septic Permit Fee: ........ <br /> <br /> 41.28 <br /> ............. Total Fees; <br /> <br />~ALIDATIONS-' ...... ' ....... <br />ZON'~ q~ SEPTIC TANK <br /> <br />m,-: H .... <br />I agree tO build ~cordi~ m ~e subm/~ pla~$ a~ ~ifi~t~m. ~e la~ of ~e S~te of Or~ a~ ~e Or/dnan~sofM~ion <br />C~ntF. Permit expkes if ~rk not ~mm~ Wl~h/~ 1~ ~e~ / furrier expr~ warran¢ ~a¢ I comply with the p~ovF$/ons of ORS <br />701,,~ to 701, ~25 <br />( j i ~m a r~er~ ~ildcr m ( ) ~e au~oriz~ r~re~n~/w of a r~i~r~ butlder <br />T~e ~rk will ~ pe~ by a r~i~ buil~ <br /> I am p~ormi~ ~r~ o~ e prope~ / Own or ~upy <br /> <br />REMARKS: N~ ~9~ercial use of ~,is <br /> <br />I h~v~ read thi~ application in /ts entirety and certify that the s~ate~ information is true and correct to the be~t of my i{flowle'Jge,, <br /> <br />SIGNATU R E 0 F App L, CANT: ...."..~..~-.~.,~/ ~)~.-- .~.,.~ <br /> PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works: <br /> Other permits required bV this dept'- Plumbing [] Electrical <br /> <br /> <br />