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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOC, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of a registered builder. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE[ <br /> <br />Situs ~OBnES~J~NUY FUL'f'Z CON~'FRUC:F:[ON <br /> <br />CONSTRUCTION TYPE: OCCUPANCY; <br /> <br /> ' CONYRACT CITY: <br />5983 WALJ. NA COURT ~E <br />AU~VI L L E DR.-9 Z 3~2, <br />USE OF aU~,r)~NG; MAR/ON COUNTY <br /> <br />NO <br /> <br />MAILING ADDRESS: <br /> <br />SUSOIVlSiON: <br /> <br />RDLLiNG GREEN ESTATES <br /> <br /> PHONE: '769-5385 S,[ i'E Nur.4[5'ER: '!0585 <br />LOT:BLOCK: ' 8E~YIoN: ...... T~5~hiFi , ~¢,N~8,LUAT .~ ON: ZONE: MAP: <br /> <br />W~DTN: ~ ~ DEPTH: 1 ~ AREA'. ~ ' <br /> ' UNITS: 8~ IRREG LOT: ~ CORNER; AR 49 <br /> ~,,$6 41,2 SF YES ;,, N0 <br /> <br />TYPE: PLUNt~ ,lNG <br /> <br />PERNI'f' OR A.°PL~,CA'f'ION NO: <br /> <br />CON'fRACTOR, NO. 52354 <br />RANDY FUL'IZ CON~TRUC'f'[ON <br />'!9047 S']'AY'!'ON RD SE <br />Aur4sV~LLE, OR <br />PHONE: '769w5385 <br /> <br /> ['f'6r4 <br />WATER LiNE~, 'iS'f' 109 FEET <br />SEWER L[NE$, 1S'f' 100 FEET <br />FLEET SUR%HARGE -ZONE 3 <br />PLUmBiNG ~'IAf'E SUF~CHARGE <br /> <br />PAYEg: <br /> <br />TOTAL ,MSSE~ED FEE% <br />PRE¥iOLIS RECEIPTS <br />'I'Hi~ RECE[P'r <br /> <br />QUAN r,[ TY AlVfOUN i' <br />~ $2o.L~0 <br />1 <br /> $3.84 <br /> $2- 5o <br /> <br />$58.34 <br />$55.34 <br /> <br />BALANCE DUE <br /> <br />RECEIPT NO: <br /> <br /> RECEIVE[]) t::)Y: Pt~ TYPE: CHECK ~t: 0 <br /> <br /> * THi~ IS A VALID PER~4!T >~ THZA8 PEI:~/IT ~PiR~ 180 DA~ <br />~'f~CTi~ C~ FOR A PERIOD OF 180 ~, OR iF ~]'~CTI~ P'A~ TO NEET ALL <br />R~iREN~'f'5 OF STATE ~ ~O :~Ri~ ~NTY BUILDING AND Z~[NG ORDINANCe, THiS PEI~i'I' <br />~ALL 8~E NULL ~D VOID, <br /> <br />/'~.~ARKb: NL ,E,L R~3994 /~ ~ <br />DONALD E, NOOr)L.6y, MARION COUNTY BU,tLD,[NG OP'F,[CiAL / BY ................................................ ~ <br /> <br />O'~ FICE COPY <br /> <br /> <br />