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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:: B88-5147 8::00 - 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7'904 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> I,)AfP,,, 0'//30/91 I flV},~: <br />OWNER <br /> LANKI'-f,.)RL~, BOB R. <br />51TUS ADDRESS <br /> <br />1 '! · 04. ~ 50 <br /> <br /> 11688 WARBLER LANE NE <br />A(J K~OR,a OR 9?002 <br /> <br />USE OF BUILDING <br /> <br /> CONSTRUCTION TYPE <br /> <br />¢4ARION COUN 1Y <br /> <br />NO <br /> <br />CATEGORY <br /> RESIDEN I IAL <br /> <br />OCCUPANCY <br /> <br /> R-3 <br />OCCUPANT LOAD <br /> <br /> N0 OF 8EDR00MS <br /> <br />AL 5CHMiE/'HAMER - AGENi 654-4179 <br />¢'-~O BOX 68597 OAF, GROVE, ORE 9?269 <br /> <br />LOT <br /> <br /> BLOCK SECTION <br />10 19 33 <br /> 70 ] 0 f <br /> <br />SUBDIVISION <br /> <br />CENTURY MEA0(,)~I5 PHASe: 4 <br /> <br />3~ <br /> <br />VALUA T ][ON: <br /> <br /> 1W ~R <br /> YE5 NO <br /> <br />MAp <br /> <br />903329. <br /> <br />Ivl()k¢lLE HO~E S/AlE SURCNARGB <br /> <br />fOFAL ASSESSED FEE5 <br />PREVIOUS R~CEiPTS <br />fH~S RECEiPt <br /> <br />QUAN TI fY AMOUN I <br /> ¢89.25 <br /> lb. ?b <br /> $8 2_*, <br /> $5. ::'O <br /> <br />$0,00 <br /> <br /> BALANCE .0UE <br /> <br /> : ~ ~ RECE i P T <br />PAYEE <br />RECEIVE[] BY: Dlvl2 ,~_ TYPE: CHECK .~; (.) <br /> <br />$115.50 <br /> <br />* THIS iS NOT A PER~IIT. THi~ APPLICATION I~tJST 60 THROU614 A REVI~ PROOE~ ~ERE THE <br />~OLLONiNG fc¢JST BE (:~IPLETEB+ IT 15 THE RESPONSIBILITY OF THE APPLICANT TO AS.9~ ]HAT <br />,ALL NECESSARY iNFORI~IATION HA~ BEEN PROVIDED. <br /> <br />FORM ~ MO ~6-~ REV 4¢0 OFFICE COPY <br /> <br /> <br />