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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH sI~E'I3,T,,~E <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br /> I am performing work on aproperty I own of occupy, <br /> I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT: <br /> <br /> The work will be performed by a registered builder. <br /> Other_ <br /> I have read and agree to the terms stated on the reverse side of DATE; <br /> this document. <br /> <br />~TE: 06/30/88 TIME: <br /> ~ CATEGORY: <br /> ST ~R~ PAR~ ~ ?5300-2?0 <br />S~TUS ADDRESS'. CONSTRUCTION TYPE; , OCCUPANCY: <br /> : 5N , / <br /> 9168 SILVER FAL~ H~ SE ~'~'~+~ ~l ~OOOUPANT LOAD: <br /> AU~VILLE OR 97325 [ .' ' <br /> ~BI.~_.~ZX :,,~ N~ <br /> <br />CONMERCIAL <br /> <br />MAILING ADDRESS: OHURCHES' AND O'TMER REL. t'GtOUS'-BU]:'L:D~-~,~rcis,$~ <br /> <br /> ED SHEEHAN <br /> 3896 CLOVEROALE DR SE TURNER 97392 <br /> PHONE.- ?43-209? i SI'TE NUMBER; 25?8 <br /> i VALUATION: $2,000. O0 <br />LOT: ! BLOCK'. SECTION; i TOWNgHIP; "~ .... !Z6~E : <br /> <br /> 49 <br /> : 13 <br /> WIDTH: !DEPTH; i AREA: ~, UNITS: IRREO, LOT: <br /> , NO I NO <br /> <br />TYPE: BUILDING PEF~4IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 12192 <br />ADAi'4 ZIEBART <br />7750 AUivlSVILLE HNY SE <br />SALEM OR 97301 <br />PHONE: 363-8202 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />FLEET SURCHARGE -ZONE 3 <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br /> 5167 <br />ARCHITECT/ENGINEER, NO. <br /> <br />TOTAL AS~.E~SEO, FEES <br />PREV[OUS.RECEIPTS <br />T~IS' RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY AI~)UNT <br /> ~32.50 <br /> 21~13 <br /> $3.84 <br /> ~1.63 <br /> 1.63 <br /> <br />$0.00 <br /> <br />PAYEE: 6~...~,-'~ <br />RECEIVED BY: cr ............... _ TYPE,; CHECK <br /> <br />THIS IS NOT A PERHIT - THIS IS A REFUND DOCUMENT' <br /> <br />REf¢ARKS: REFUND OF UN-ISSUED APPLICATION <br />HEIGHT: TOTAL SQFT: STORIES: <br /> <br />PLAN.ACTION: <br /> <br />~O,M ~ MC ~-~ ~V ~m~ OFFICE COPY <br /> <br /> <br />