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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> am performing work or~ aproperty I own or occupy. <br />am a registered builder OR( )theauthorJzed representative <br />of a registered builder, <br />The work will be performed bY a registered builder, <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />7757 ~HEF~ RD <br />AUlvlsV i LLE OR <br />U~E OF BLIILD~NG: ...... <br /> <br /> TAX LOT: <br /> <br /> CONSTRUCTION TYPE: <br /> <br /> 5 -N <br /> SE ~5NTRACT CITY: UG@: <br />97325 <br /> ~,Ri ON (;A3UN 'I'Y NO <br /> <br />CATEGORY: <br /> R~ i 0EN'f' l AL, <br />OCCUPANCY: <br /> <br />OCCUPANT LOAO: <br /> <br />SiNGLEFARiLY DWELLINGS <br /> <br />510 ~ 7TH <br />SUBLIMITY OR 9'1385 <br />PHONE: 789-5969 <br /> <br /> i ; 1. 387 <br /> <br />CAMELLIA HEi(.~HI'E. NO.3 <br /> <br />SiTE NUIVlBER: <br /> VALUAi[ION: <br /> <br /> 10906 <br />$57,7~6.00 <br /> <br />, AC NO YES <br /> <br />48 <br /> <br />· FYPE: BUILDING PERMIT OR APPLICATION NO: <br /> <br />CON'fRACfrE~, NO. <br />ANDAL, O.F. & B.J_ <br />510 .~N ?TH <br />~AJBLiMiTY OR 97385 <br />PHON~: 769=5~69 <br /> <br /> I T'FJ'~ <br />BUILOIN6 FEE <br />PLAN <br />FLEET 81..IB..2RARGE -ZONE 3 <br />BUILDING STATE ..~UROHAk'6E <br />ZON 1N6 SURCHARGE <br /> <br />PAYEE: <br /> <br /> 26289 <br />ARCHI'fE~T/ENGINEER, NO. <br /> <br />TOTAL <br />PR~¥1OLI~RECEiPTS <br />THI~RE"OI~IPT <br /> <br />~UAN'FITY <br /> <br />AiVIccl, JN'i' <br /> ~307.00 <br /> 199.55 <br /> <br /> 15.35 <br /> <br />$541.09 <br />$541.09 <br /> $o.oo <br /> <br />BALANCE DUE $0+00 <br /> <br /> RECEIVED BY; PS TYPE: CHECK ~: 0 <br />* THiS IS A VALID PER2fllI' ~< THi:s pER~II'F EXPiR~ 180 DA~ F~ ITS I~E ~I'E+ IF <br />~s'r~C'f'I~ C~ FOR A P~[O0 ¢ 180 ~, OR IF ~'r~CTi~ F'AI~ TO MEET ALL <br />RE~IREMEN'FS OF STATE ~ ~D ~RJ~ ~N'rY BUILDING ~D Z~ING ORDiN~C~, THiS PEJ~I'T' <br />~ALL 8E~E NULL AND VOiD~ <br /> <br />SETBACKS; FR 20 LS 20 R~...1D RR..30 $~ ........... <br />R~RK.St NF_.~"Rb~ <br /> <br />HEIC~II'~ TOI'AL ~ FT: 2116 S'rORiB: 1 <br /> <br />DONALD E. ~OLEY, ~RI~ COUNTY ~UILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />