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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 have read and agree to tf~o terms stated on the reverse side of <br /> <br />(35/93/91 f ,~4E = 13.'24.'33 <br />NAiiQNAL FQR~-S~ LANDS <br /> <br /> HALL~ RIOGE SUIVI~I f <br />DEl RiOT OR <br /> BUILDING <br /> <br /> TAX LOT CATEGORY <br /> COMIv] .F..RC i AL <br /> <br />CONTRACT CITY 5~'~B OCCUPANT LC-/A0 <br />~RiON COUNIY NO N~ OF ~EL.~OOM~ <br /> <br />~A.~Ne ACnRESS PUBLIC WORK5 AND UTiLiTiES 8UiLDIf,,~¢~O~wS,ON <br /> <br />D~IROiI RANGER OlSl, <br />NC 60, BOX 320 MILL CiTY 9?360 <br />PHONE: <br /> <br />lOT BLOCK SECTION TOWNSNIP <br />WIDTH DEPTH AREA OB UNITS <br /> <br />5Iig NUMBER~ <br /> VALUATION: <br /> <br /> 13049 <br />$22,500.00 <br /> <br />1~ IRREG LOT 5E CORNER TC 104 <br /> NO NO <br /> <br />IYPE; BUILDING PER~4iF OR APPLICArlON NO; <br /> <br />CONIRACIOR, NO. ROHN <br />ROHN COfClIVlERCIAL PROOUCfB <br />PO BOX 1'70249 <br />81Rf41NG~AN AL 35217 <br />PHONE: <br /> <br /> ifg~ <br />BUILDING FEE <br />PLAN Rg¥igW <br />BUiLDiNG 5~ATE SURCHARGE <br />ZONING ~%JRCHARG~ <br /> <br /> 9032411 <br />ARCHITECi/ENGINg~R, NO. <br /> <br />PHONE: <br /> <br />TOTAL ~5~SED FEE5 <br />PREW i OUS RECEIPTS <br />IHiS RECEIPT <br />BALANCE CUE <br /> <br />~UANflIY <br /> <br />A~OUNT <br /> $158.50 <br /> $103,03 <br /> ~'?.93 <br /> Y,93 <br /> <br />$277.39 <br /> $o.o0 <br /> $0.00 <br /> <br />$2Y?.39 <br /> <br />PAYEE <br />RECEIVED BY: PB ]YPE: CldgCK ~: 0 <br /> <br />~: lNi5 15 NOT A PER~4iI. IHiS APPLiOAIlON f4JSl GO THROUGH A RBVIP.,~ PRO~ES,5 WHERE 1Hb <br />POLL~N6 ~Sf' B~ 6~PLEf'ED. ~' iS RE~5~aiLIfY O~ THE APPLICANT ~O ~URE ~HA~ <br />ALL NECESSARY iNFOR~fi~ H~ BEEN P~ViDED. <br /> <br />PLAN REVIEW: 8Y .......... DATE ........................ <br />CI'IY JURISDiCTiONt BY <br /> <br />5EP~'IC: BY DATE ~ <br /> ":- ;;'"'; . " <br />R~C, tARKS: P~C~FAJ:~RICAfSO MOIL~JLE'"F~OR 6~NiCAr~' "BAL ~E <br /> <br />H~IGNi: 9 r'OfAL ~Q Fl: 0 S1ORiE~: <br /> <br />I,)A T .~ <br /> <br /> / ~z~ 5P <br />RS /~' RR <br /> <br />OFFICE COPY <br /> <br /> <br />