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Appl. Rec~,; <br />By: Dottle <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building <br /> 220 High St,, N.E, 2nd Floor Permit NO ' 85-1233 <br /> Salem, Oregon 97301 <br /> Do, tie <br /> 588~5147 -- 588-5148 By: <br /> <br />5:00 P,M ....................... ~ . COOE~A~Phone~ . ~ ...................... . 8:00 A.M. Date: 12/5/85 <br /> <br />Type of Permit:_ /~"~E~-~'-/C'~J'O//"/~ ...~/~.A.~ .Tax Lot No' ~O - O O __ <br />Address: //~¢~ ~/~ E~ ~. Sec.: ~ Twnshp' ~ Rge.: ~ <br /> <br />Bier, & No,: ~~ 5[¢ .Phone; ~ ~ ¢¢/7 Address: ~ ¢¢¢ ~~'~' %~ <br /> <br />Plans by: .Phone: Address: ........ <br />.............................Hr'dj ID <br /> <br />Lot No.: BIk. NO.: £ub, dv ' <br />Area of Bldg. 2nd Base- Total <br /> 5x18 <br />Main Fir,: .Fir.: __ment: Area; <br /> <br />Root Type: __ Truss/Stick; <br />Heating Wood Water <br />System: __ _Stove: Supply: <br />Septic Tank New <br />Site Eval.: __ _Instal.: <br />Exist, NO. <br />System: _Gals,: <br /> <br /> 29' <br />Height: <br /> <br />VALIDATIONS; <br />Zoning: <br />Date: <br />Septic Tank: <br />Date; <br /> <br /> Mechanical: <br /> .Date: <br /> Plans: ~/ <br /> <br />I agree to build according to the submitted plans and $pecifications, the laws of the <br />State of Oregon and the Ordinances of Marion County. PERMIT EXPIRES IF WORK <br />NOT COMMENCED WITHIN 180 DA YS. I further expressly warrant that I comply with <br />the provisions of ORS 701.005 to 701,125 because: <br /> <br /> ) I am performing work on a property I own <br /> or occupy <br />( ~) I am a registered builder OR ( ) the <br />· ~, authorized representative of a <br />registered builder <br /> <br />__Lot Size;, Corner?. <br /> Valuation~ 4-10~6f/~O00 <br /> Bldg. Permit 2.23 <br /> Fee: (+ 5%) <br /> <br />Elect, Fee: <br /> <br />Math, Fee: <br /> <br />Plumb, Fee: <br />State <br />Su rcharge:~.,(,4%) 1.78 <br /> <br /> 28.93 <br />Plans Chk. Fee: <br />Septic Tank <br />Permit Fee: <br /> <br />DEQ Surcharge: <br /> <br /> TOTAL FEE: <br /> BLDG. <br /> RECEIPT NO' <br />( ) The work will be performed Driveway <br />by a registered builder Permit Fee: <br />( ) Other (please specify) Site Plan <br /> Review Fee; <br /> Public Works <br /> Receipt No,: <br /> <br />77.44 <br /> <br />/ <br /> <br />I have read this application in its entirety and certify that the stated information is true and correct to the best of my knowledge. <br />SIGNATURE OF APPLICANT: ~ ~ ~'-g~"~ ~!~ ~~'/ <br /> PLEASE NOTE; DrJ s <br /> Y ' a ' spection are required by Public Work~: 588-5036 <br /> <br /> Other permits required by this clapt.: Plumbing B Electrical ~ Mechanical B <br /> <br /> <br />