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Monday <br />Apph Ray, C;' __ <br /> <br /> 12-17-79 <br />Date: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Bui]ding ¢~ 225 <br /> 220 High St., N,E, 2nd Floor <br /> Salem, Oregon 97:301 <br />R.H. WlTHROW, BLDG, ADMINISTRATOR <br />588-5147 -- 588..6148 <br /> <br />Type of Permit: /LDE,~,~UACY <br /> .,,,, 'fax Lot .NO: <br /> 20822 O].mstead ROad i,qC 28 ~$ 1W <br />Address'. Sec. __ Twnshp. __Rge. <br /> <br />Owner; S~f~v~st;er !?vl~cek Phone:678-5709 ~ Address; su~e a~ above <br /> <br />Bldr. & NO.: Phone; Address: <br />MapPage ~j Zone~ ~ Zone Chg. Part, Cond, U~e ~ Variance FireZone ; Occupancy [Tvpe of Const. <br /> <br />Lot No; __ __.81k, No;__ Sub dy. Lot Size 2 1/2 act $ ~ <br /> <br /> well <br />Water Supply; <br />Sewage exlsting <br />Disposal: <br /> <br />Area of Bldg: <br /> <br />Basement: __ <br /> <br />Heating <br />System; __ <br /> <br />BTU; <br /> <br /> Valuation: $ <br /> Site <br /> Evah Permit Fee;__ <br /> <br />28 × 66 Stories; S~ate Surcharge: <br /> Roof <br /> Type; Plans Chk. Fee: <br /> Ade qu~,.cy chock <br /> Septic Permit Fee; 2~.00 <br /> <br /> Total Fees;__ 2~.00 <br /> <br />I agree to bo/id according to the submitted plans and specifications, the lav¢$ of the Stare of Ora~lon ~nd the Ord/n,~ncas of Marion <br />O°unty' Perm/t expire$ i£ w°r~mrenced/~v/th/r~ '20~-~Y$' <br />S~G~ATORE OF APPUCAN~ X~~~ <br /> <br /> ~EMARKS <br /> If ~ ~ss,,~ ~&~ d ' ~Y ~~t T <br /> <br />mobile homo will be removed upon placement of new mo home. <br /> <br />PLEASE NOTE; Drivew.ay and sidewalk inspections are required by Public Works; 588-5036 <br />Other permita required by this dept: Plumbing [] Electrical [] <br /> <br /> <br />