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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALt:M, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />The work win be performed by A registered builder, <br />Other <br />I have read and agree to the terms stated on the reverse side of <br /> <br /> DATE: 08/20/92 TIME: i,$:51:49 <br /> <br /> 5-NH1- <br /> 11115 JAMEG WAY SE <br /> AUMSVILLE OR 97305 '~O~'f~"/*O~'8 OCCUPANT LOAD: <br /> <br />CMAILING ADDRESS: ~SUeOIVISION: g -CAME LIA <br /> HEIGHTS <br /> <br />P,O. BOX <br />STAYTON, OR <br />PHONE: <br /> <br />VALUATION: $8,640.00 <br /> <br />]_OT: ,SECTION ; RANGE'. ZONE; <br />WIDTH'. ;DEPTH; J AREA'. 2. 7 j UNiT~C ; IRPf~. LOT'. I COFfeR: <br /> <br />TYPE: BUILDING PERMIT OR APPLICATI0N HOc <br /> <br />CONTRACTOR~ NO, <br />YOUMANS~ TOM <br />P.O. BOX 632 <br />STAYTON, OR 97383 <br />PHONE: 769-7544 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE GURCHARGE <br />ZONING SURCHARGE <br /> <br />PAYEE: <br /> <br /> 9040519 <br />ARCHITECT/ENGINEER~ <br /> <br />PHONE: <br /> <br />NO. <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $74.50 <br /> $48,4S <br /> $5.75 <br /> <br />TOTAL ASSESSED FEES $130.59 <br />PREVIOUS RECEIPTS $77.89 <br /> $0.00 <br /> <br /> $52.50 <br /> <br /> RECEIVED BY: MB ........ =~'LL__Z% ............ ~2 ...... TYPE; CHECK ~: 0 <br /> <br /> · THIS IS NOT A PERMIT. THIS APPLICATION MDST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. iT IS THE APPLICANT TO ASSURE THAT <br />LL NECESSARY iNFORMATIONHASBEEN]PEOV~BE~- <br /> <br /> PLAN REVIEW: BY OATE HEIGHT: ,10 SETBACKS: FR 20 <br /> ZONING: BY .......... DATE?-~ .......... TOTAL SQFT: 1440 LS-5 <br /> <br /> ::PLAN.:AGTI:ON: RR~]5 <br /> CITY JURISDICTION; 8Y ........ DAT~ ......... ENERGY PATH: SP ....... <br /> <br /> REMARKS: STORAGE BLOB (POLE) APPROVED FORPRIVATE NONCOHMERCIAL USE ONLY <br /> <br />~o~,~ MC ~-~ ~V, ./~ OFFICE COPY <br /> <br /> <br />