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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:20 P.M. - 8:00 A.M. <br /> <br /> Other <br /> I have read and agree to the terms stated on the reverse side of <br /> <br />DATE: 11/02/88 2;59:47p <br /> Ex)RAN, TOM <br />:SITUS ASb~ss: <br /> <br /> 880 8TH <br />AUMSVI LLE OR 97325 <br /> <br />TAX ~iO~: :' CATEGORY'. <br /> 90040-500 ~ RESIDENT, IAL <br /> <br /> 5'-N : <br /> <br /> ..... St. NGLEFAMILYONELLINGS .................................... ].].( ~ ....... <br />MAIlinG ADDRESS: : SUBDIVISION: <br /> DEL MAR III <br /> <br />FO 8OX 185 <br />SUBLIMITY OR 9?385 <br />PHONE: 769-7284 <br /> <br />?5 <br /> <br /> SITE NUMBER: 5804 <br /> VALUATION: $32,500.00 <br /> <br />'~REA; 5625.00 : SF NO i NO <br /> <br />7¥PE: BUILDING PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 55493 <br />TOM DORAN <br />PO BOX 185 <br />SUBLIMITY 97285 <br />PHONE: 789-7364 <br /> <br /> ITEM <br />BUILOING FEE <br />PLAN REVIEW <br />FLEET SURCHAFb:BE -ZONE 3 <br />BUILDING STATE SURCHARGE <br /> <br /> 9012298 <br />ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: <br /> <br /> TOTALA~ESSE~:FEES <br />PREVIOUSRECEIPTS <br />THIS]RECEIPT <br /> <br />OUA~TITY <br /> <br />AMOUNT <br /> $208.50 <br /> $134.22 <br /> $3.84 <br /> $10.33 <br /> <br /> $354.90 <br /> $o.oo <br /> $354.90 <br /> <br />ALL NECE"SS, ARY INFORMATION HAS. BEEN PROVIDED.: <br /> <br />SEPTIC; 8Y DATE <br />ZONINGt BY <br /> <br />REMARKS: NEW RES <br />HEIGHT= ]4 <br /> <br /> BALANCE DUE :]]:, $o.oo <br /> <br />PAYEE; TOM BOP, AN /~' .::]i 12051 <br />RECEIVED BY: ~ .Fy// ' 'TYPE: IN'~i; CHECK ~: 2447 <br />m THIS IS NOT A PERMIT. THis APPL'IOATION MUST'GO:TH~ ,~ R~IEN PROO~ NHERE THE <br />FOLLOWING MUST BE COMPLETED. IT ISTHE TO A,SBURE THAT <br /> <br /> CITY JUR,ISDIO~ION: BY DATE <br /> <br /> DATE ......... SETBACKS: PR--20 RS-5 PR-5 SP- <br /> <br /> TOTAL SO PT: 1328 STORIES: 1 PLAN.ACTION.- <br /> <br />FORM ~' MC 15-56 REV.~/87 OFFICE COPY <br /> <br /> <br />