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Appl, Revd; <br /> <br />By: <br /> <br />Type of Permit: ~nsulntion {n cei[~n$ <br /> <br /> Nc~l Dickman <br />O~er; Phone; <br /> <br /> DEPT. OF BUILDING INSPECTION <br /> DoWr~town Senator Building <br /> 220 High St,, N,E, 2nd Floor <br />Sele~, Oregon 97301 <br />~.J,L WITHRO1/V., BLDG. ADMINISTRATOR <br />588-5147 -- 588-5148 <br /> <br />Tax Lot No: <br /> <br />Sec. ~Twnshp ......... Rge, <br /> <br />76905~68 A~dress: same ,. <br /> <br />Bldr. & NO.: .... Phone: .... Address; <br />Plans by: Phone; AddresS: <br /> <br />Lot No: ...... BIk, No:. Sub dy, Lot Size, Corner? <br /> <br />Water Supply; we ). I Valuation; ~ 500.00 <br /> <br />Sewage Feas, 5.00 <br />nispo~al: ........ se[~toc Study: Permit Fee:. <br /> <br />Area of Bldg; Stories; State ~;ureharge: .~0 / <br /> Roof <br />Ba~ment; __ Type: Plan~ Chk. Fee: <br /> <br />System: Septic Permit Fee; <br /> <br />BTU: Total Fees: 5. ?D ......... <br /> Rcpt. NO: ,,, ~.~(' -- <br /> <br />VALIDATIONS: <br />ZONING <br /> <br />SEPTIC TANK PLANS <br />~y~ ~. /~,~/d' <br /> <br /> REMARKS <br /> <br />PLEASE <br /> <br />MARION COUNTY BLDG. INSPECTOR <br /> <br /> // // ?tx) <br />DATF ~'~--// / 0 <br /> <br />......... , ............. ~,~ .......... ~ .... , .......... kS: 588-5036 <br /> Other I~ermits required by this dept: Plumbing C] Electrical [] <br /> <br /> <br />