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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 8::00 - 4::30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy <br />lamaregisteredbullderORi Itheauthorizedrepre'~en~ative <br />of a registered builder <br />The work will be performed by a registered builder <br />Other <br />I have read aRd agree to the terms stated On the reverse side of <br /> <br />SIGNA'f'UF~E OF APPLICANT <br /> DATE <br /> <br />NOACK, IV,ARK <br /> <br /> 189 N 8iH sr <br /> AUIvlSV I LLE <br />USE OF BUILDING <br /> <br />OR 97825 <br /> <br />AUI~t~'V i LLE <br /> <br />5-N <br /> UGB <br /> <br />NO <br /> <br />CATEGOHY <br /> RE51 DEN [ i AL <br />OCCUPANCy <br /> <br /> Rw3 <br />OCCUPAN I LOAD <br /> <br />NO OF <br /> <br />MAlt, lNG ADDRESS SINGLE FANILY [;~ELLINGS <br /> <br />SUBDIVISION <br /> <br /> P.O. 80X <br /> <br />~ OT BLOCK <br /> <br />100 108 <br /> <br /> SiIE NUIV~ER: <br /> VALUA'f[ON: $5,700.00 <br />SECTION TOWNSHIP RANGE ' ZONE MAP <br /> <br /> 25 8S <br />AREA UNITS IRREG ~OT CORNER <br /> <br /> 10800. SE NO <br /> <br />TYPE: BUILDiN6 PEP, MI1 OR APPLICArION NO: <br /> <br />C(,,~rRACTOR, NO. 255?? <br />H~KiN~ GENERAL CON IRAC~OR <br />3150 ~O <br />~""""""""""""""""""~ALE~, OREGON 97302 <br />PHONE: 362-8065 <br /> <br />~UiLDING PEE <br />PLAN REVIEW <br />FLE~F SURCHARGE --ZONE 3 <br />BUILDING ~fAl~ SUF~ARGE <br /> <br />PAYEE: HOSKiN$ GENE~,L C'ONFRAgTOR <br /> <br /> 9028084 <br />ARCHIr~'r/ENGINEER, NO. <br /> <br />TOTAL ~ESfSED <br />PREVIOUS RECEIPTS <br />FHi$ RECE[P'f' <br /> <br />QUANIiIY <br /> <br />AIvK,:XJNI <br /> 36.73 <br /> $2.83 <br /> <br />$99.90 <br /> $o.o0 <br />$99.90 <br /> <br />BALANCE DUE $0.00 <br /> <br />29680 <br /> <br /> RECEIVED BY: GL TYPE: iN CHECK ~: 0 <br /> ~ fHI~ ~$ NO~ A PERtqII. 1HiS APPLICA'f[ON F~JS[ GO I'HROUGH A REVIEW PROCES,~ ~HERE <br />FOLLOWINGIV~U$F BE C~PLE',~O. IT IS THE R~SIBILITY O~ THE APPLi~NT ~RE fHA~ <br />ALL NECESSA~ iNF~ H,~ BEEN P~ViDED. <br /> <br />SEPFiC= BY DAtE <br /> <br />ZONING~ BY DATE SEIBACKS,: <br />RE~NIARK$: FOL]NDAI'~ON REPAIR ...... <br /> <br />HEIGHI: 18 IOiAL ~ Fi: O <br /> <br />C[lY JURiSDJCIiON: BY DAI'E <br /> <br />FR L$ R~ RR SP <br /> <br />$10RIES; 1 PLAN.ACf[ON: <br /> <br /> OFFICE COPY <br />FORM # MO 15-56 REV 4/90 <br /> <br /> <br />