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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 <br /> this document. <br /> DATE: 10/22/87 TIME: 10:29;139 <br /> <br />OWNER; ST NARys PARISH <br /> <br /> SENATOR BLDG. NO. 225 ~_.2./~f//~.~;~/,...~ <br /> 220 HIGH S-'rJi~._ET NE <br /> SALEM, OREGON ~7301 ~ ~ ::'=' <br /> <br />PHONE 588-~147 ~ ~~ <br />CODE-A-PHONE 4:30 P.M.- 8:00 A.M. // I ~. ~( / <br /> <br />SITUS AODRG$S: <br /> <br /> 9168 SILVER FALLS HWY <br /> AU~VILLE <br /> <br />USE OF Bud-biNG: <br /> <br />~Ai~IN~ AD~RESSZ <br /> <br />PHONE: <br /> <br />LOT; BLOCK: <br />WIDTH: DEPTH: <br /> <br />' ~ATEGORY: C <br /> <br /> OCCUPANCY:/ <br /> <br />!OCCUPANT ~OAD: <br /> <br /> ; SITE NUMBER: 2578 <br /> VALUATION: $2,000. O0 <br /> <br />13 ; 8S : 2W AR3 49 <br /> <br />TYPE: BUILDING PER~IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 12192 <br />ADAN Z IEBART <br />7750 AUMSVILLE HNY SE <br />SALEN OR 97301 <br />I::~ONE; 363-8202 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />FLEET SURCHARGE ~ZONE 3 <br />BUILDING STATE SURCHARGE <br />7ON ING .~AJ RCHARGE <br /> <br /> 900516? <br />ARCHITECT/ENGINEER, NO. <br /> <br />TOTAL...AS~I~ED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />PAYEE~ ADAH ZIEBART ~-~ _ ~ /'7 <br />RECEIVED BY; JB ,,,,· TYPE: CK <br /> <br />QUANTITY AIV~UNT <br /> $32.50 <br /> $21.13 <br /> $3.84 <br /> $1.63 <br /> $1.63 <br /> <br />$0.00 <br /> <br /> 5727 <br />CHECK ~: 5058 <br /> <br /> ' T <br />* THIS IS NOT A PER,lIT. THIS APPLICATI'ON .r4:JS~ 60...~HROUGH. A REVIEN PROC~ K~tERE HE <br />FOLLOWING IWJST BE COMPLETED, I~ IS THE RESPON$1'B'ILI'.~.OFTHE. APPLIC~T TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY DATE, .... <br /> CITY JURISDICTION: BY DATE .......... <br /> <br />SEPTIC: BY DATE ....... <br />ZONING, BY_.~-'~_~_Z~ DA TE~z/'_Cc_~__-'~'_:'~_._-_~?SETBACKS: FR'- ~ .... ~-__~--~--'-~-____ <br /> <br />REMARKS: STAIRWAY & FINISH 2ND FLOOR <br />HEIGHT: TOTAL SQ FT: 0 <br /> <br />STORIES; <br /> <br />OFFICE COPY <br /> <br />2 PLAN.ACTION: <br /> <br /> <br />