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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 58,8-5147 <br />CODE-A-PHONE 4:30 RM. - 8;00 A,M, <br /> <br />am e registered builder OR ( ) the authorized representative <br /> work will be ¢erformed by ~ registered builde~ <br /> <br />AUMSV[LL~ (DR 9?325 <br /> <br />SINGLE FAF',ILY DNELLINGS <br /> <br />SIGNATURE OF APPMCANT~ <br /> <br /> DATE: <br /> <br /> 9035 ! ..-00 ' <br /> <br />AUMSVI LLE <br /> <br />SUBDIVISION: <br /> <br />~ " 25 <br /> '?0 ? 08 <br /> <br />Gl LO0~ ~2 <br /> <br /> V,a LU.AT'[[ ON; <br /> <br />85 2~ <br />SE YES <br /> <br /> 8338 <br /> $33,500. OC:: <br /> <br /> RS 5: <br /> <br />NO <br /> <br />, f ..... UILD..NG PERJVilT OR APPLICATION <br /> <br />CONTRACTOF~', NO_ 55493 <br /> <br /> BOX '] 85 <br />SUE~L, IMI TM 97385 <br />,:~HONE: 769-?354 <br /> <br /> I T EM <br />¢3L1'[ LO ING FEE <br />PLAN REV I E~,r <br />FLEET SURCHARGE ~ZONE 4. <br />E~LI:[LD,"NG STA~ SL1RCHARGE <br /> <br /> 9018774 <br /> <br />ARCH ~ TEC-F/ENG~NEER, <br /> <br />~HONE: <br /> <br />TOTAL'ASSESSED <br />PREVIOUS REOEIPTa <br />!H~S RECEIPT <br /> <br />Gl,JAN T ! TY <br /> <br />$ 2; i . 00 <br />$ ! 3 ?.: 5 <br /> <br /> z~ALANOE DUE }0, <br />RE~EIVE .... PS ~ YPE: ,N CHECK ~: <br /> <br />¢;'OLLON[NG MUST BE .OMPLETEg. ';T,,,'iS THE RES¢ONSZBZ, I_ZTY O'F THE ,AF;PL~CANT TO ASSURE 'q..tA,' <br />ALL. NECESSARY INFO~ATiON H~S ,8E~ PROVIDED <br /> <br />SEPT lC: ETM DATE' <br />.£uN~ ~t~. OA-~ S._T~ACK,~; -'q--2C L$~.5 <br /> <br />CITY H..IR!SD!C]iON; S~ ....... O/lm~ ................. <br /> <br /> RS-5 RR.-5 3P'~ <br /> <br /> ,AC,~,JN; <br /> P~AN "~" <br /> <br />FORM ¢ MC rD-08 ~EV 11/~ OFFICE COPY <br /> <br /> <br />