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,RION 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 /> <br />I am performing work on a property I own or occupy, <br />t Am a registered builder OR ( ) the authorized representative S~GNATURE OF APPLICANT'. <br />Of a registered builder, <br />The work wiU be performed by a registered builrer. <br />Other <br />I have read 8nd Agree to the terms stated on the reverse side of DATE: <br />this d0cumen~, <br /> <br />-W~I;)A:T:E: 04'Z:] 4'/92En~ - - <br /> BETHEL, DARRELL <br />S~¥d§ AbDBeSS; <br /> <br />9550 BATES F,XSAO. <br /> <br />TAX bDT: CATEGORY; <br /> REF31Db,'N'I 1AL <br />CONSTBUOTION TYPE: OCCUPANCY: <br /> <br /> 5"-N <br />CONTRACT CITY: L]GS; i OCCUPANT LOAD: <br /> <br /> AUIV~V i LLE OR 9?325 <br /> ~tAR ,~, ON COUN. I.¥ NO <br />USE OF BUILDING: 'NO OF BE~HooMs: <br /> <br />kAiL. IR~ XDDR~i ~? OEN'f'IAL "ACCES,5~RY $'FRUCTURE5 ........ <br /> <br /> PO BOX ~23 <br /> $TAYTON 9738~ <br /> PHONE: '769w28'74 $1TE NUt'4BER: 92w01502 <br /> VALUATION: $9~000.00 <br />LOT: ' BLOCK; ; SECTION: TOWNSHIP: RANGE~ , ZONEI MAP; <br /> <br /> , 88 AR <br />WIDTH; DE~T~i ,AREA: UNITS; IRRCG. LOT: iCORN~R: <br /> i 1.5: AC NO! YES <br /> <br />4-¸8 <br /> <br />I'YPE: BUILDING <br /> <br />CONTRAC'f'OR, NO. <br />BETHEL, DARRELL <br />PO BOX 623 <br />S']'AY'I'ON 97383 <br />PHONE: 769-2874 <br /> <br />PERfflI'I' OR APPLiCAI'ION NO: 9039391 <br /> ARCHI'T'ECT/ENGJNEER, NO+ <br /> <br />BUiLBiN6 FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br />PHONE: <br /> <br />TO'T'AL A~E~SED ~EE~ <br />PRE¥1OU$ RECEIPTS <br />'l'HI8 RECEIPT <br /> <br />QUANTZTY <br /> <br />,'A~4OUN I' <br /> $?4.50 <br /> <br /> SS. ?s <br /> $3.79 <br /> <br />$330.39 <br /> $0,09 <br />$130.39 <br /> <br />BALANCE DUE $0.00 <br /> <br /> ?A~EE: BETHEL ~ARRELL <br /> 41437 <br /> RECEIVED BY: f,~2 ,..,~.~,., TYPE; CK CHECK ~: 1036 <br /> <br />* 'f'HiS 1S NOT A PER~'f'. TH~S APPLICA'f'ZON r,4U~T eO'f'HROUC~ A REVIE~ PROCE~ ~'IERE THE <br />EDLLG~iNG ~UST BE COf4PLETEO. 1T 1~ THE RESPONSiBiLiTY OF '1'ME APPLJCAN'f' TO A~$URE I'HAI' <br />,ALL NECE~,ARY iNP'ORf4AT HAS BEEN PROviDED. <br /> <br />PLAN REViEN: BY <br /> <br />SEP'¥'tC: BY <br /> <br />ZONING: BY~ <br />REr,AARK,5': GARA~E""'(PC0LE <br /> <br />HEIGH'f': 1'7 TOTAL SQ P'T: <br /> <br /> CiI'Y JURiSDiCTiON: BY DATE <br /> DA'T'.~ ENERGY PATH: <br /> <br />DATE SETBACKS:, FR LS ~ <br /> ~__.,~..-_ ..... RR ~P~ ¢~S-~ SP <br /> <br />']?28 STORIES: I PLAN.ACTiON; <br /> <br /> ¢ OFFICE COPY <br />FORM # MC 15.,56 REV. 4/90 <br /> <br /> <br />