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W THURS <br />Appl. Reed: <br /> <br /> C~ i,~YL <br /> <br /> 5-26-8~ <br />Date: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> <br /> Salem, Oregon 97301 <br /> <br /> 588-5147 - 588-5148 <br />5:00 P.M.- ........... CODE-A-Phone 588-5373 ........... 8;00 A.M, <br /> <br />Type of Permit: COMPLETION 'PEP~'~iT <br /> <br />Address; 21690 ~'L0~S '~..Y t~E <br /> <br />Owner: J!CK ISI~ExG <br /> <br />Bldr. & NO ' " <br />Plans by: <br /> <br />FOR C(?RVEi~IE~4CE _2~RE Tax Lot No: 40316-935 <br /> <br /> Sec. 9 Twnshp, 4 Rge., <br /> <br /> 12704 ~d,~ <br /> Phone: 222-2935 <br /> <br />Phone: , Address: <br /> <br />Phone: Address; <br /> <br />M in Re~l. Front .... ~es Re=~'" <br /> <br />.Lot No.- BIk. NO.:, <br />Area of Bldg. 2nd <br />Main F]r.: Fir,: ..... <br /> <br />Roof Type: S !' ~! k e <br />Heating <br /> <br />Wood <br /> <br />_Sub dv. <br /> Base- Total <br /> <br /> Truss/Stick: : £,t[ ~, G <br /> Water <br /> <br /> Lot Size ...... Corner?__ <br /> <br />Bldg, Permit <br />Fee: (+ 5%) ?.~_SZ~.,~.;~,-- ..... <br /> 35 .o0 <br />Elect. Fee: <br /> <br />Sy s t e m :~D~_, ~,,S~,D,,D. .... Stove: <br />Septic Tank New <br />Site Eval: ...... Instal.: <br />Exist. No, <br />System: ......... 7,~ .......... Gals.: <br /> <br />VALIDATIONS: l, <br />Zon;ng:/~ ~9 ~ __/__~_~ Mechanical: <br />Dote: ~ .... Date;,~ <br />Septic Tank: Plans: <br /> <br /> ,,.~! l <br />, Supply- <br /> <br />Mech. Fee: '16.00 <br /> <br /> 55.00 <br />Plumb. Fee, <br />State <br />Surcharge: 14.46 <br /> <br />Plans Chk, Fee: 166.21 <br />Permit Fee~ . <br /> <br />I agree to build occordlng to the submitted plans and specifications, the lows of the State DEC;) Surcharge:. <br />of Oregon and the Ordinances of Marion County. Permit expires if work not commenced <br />within 180 days, I further expressly warrant that I comply with the provisions of ORS TOTAL FEE: 555 .l 6 <br />701,005 to 701.125 because: ~__..,~..~7[d <br />( ) I om performing work on a property I own or occupy RECEIPT NO.: <br />( ) I am a registered builder OR ( ) the authorized ( ) The work will be performed by o registered builder <br /> representative of a registered builder ( ) Other (please specify) <br /> <br />REMARKS: <br /> <br />I have read this applicatzbn in its entirety and certify that/~TE~tecl information is true and correct to the best of rny knowledge, <br /> <br /> PLEASE NO~~~sidewaik inspection, are ~red by Public Works: 588.~036 Other permit~ required by this dept; Plumbing ~ Electrical ~ <br /> <br /> <br />