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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 /> Of a registered builder, '~ x¢~ ~ ' <br /> Other__T"e work will be berformed by a registered builder, /"'J'" <br /> this document, <br /> DATE: 86,/01/92 TIME: 16:18:52 <br /> <br /> 11115 J/~qE¢S WAY SE ~ i <br /> AU~ViLLE OR 97~,05 : ~ONY~ACT CITY: [ UGB: OCCUPANT LOAD; <br /> MABZON COUNTY <br /> <br /> RET~ZDLqNTiAL AO~E'~..~2RY STRUO:rUR~ ' <br />:MAILING ADDRESS'. iSueDIvl$1°fl'' CAC4ELLiA HEIGHTS <br /> P.O. B~ 632 <br /> SI'AYI'~, OR 9738~ <br /> ~: 789-7544 ~)'E NU~ER~ 92~02061 <br /> VA~A'r i ~: $~, 400.00 <br /> <br /> TYPE: 8uiLOzN6 PEmi'F OR APPL~CATlm NO: 9040319 <br /> <br />CONTRACTOR ~ NO. <br />YQU~ClS, TC~ <br />P.O. BOX 63;' <br />STAY'tON, OB 97383 <br />PHONE: 769-754.4 <br /> <br /> lr TEM <br />DUi LDiNG FEE <br />P~ REVi E~¢ <br />BUILDING STATE EC3RCHARGE <br />ZeN 1NC 5~JRCHAR~E <br /> <br />PA,Y, EE: YOU~S, TON <br />RECEIVED BY: dm <br /> <br />ARO41'i'ECT/ENGiNEER, NO. <br /> <br /> QUANTITY ArqOUN¥ <br /> <br /> $2.23 <br /> $2.23 <br /> <br />TOTAL ASS~ED EErCJS $77.89 <br />PREVlOU~ ~ECEIPTS $0.00 <br />THIS RECEIPT $77.89 <br /> <br />BALANCE OUE $0.00 <br /> 42363 <br /> <br /> TYPE~ CK CHECK ~: 214 <br /> <br />· THiS iS NOT A PER~i'F. THI~ APPliCAtiON ,.~I~T:.GO THROUGH A R~WiE'W PR~ ~ERE THE <br />FOLdiNG ~ST BE C~PLETED. iT IS THE R~SiBiLiTY OF THE APPLi~I' TO ~RE l'hal' <br />ALL N~E~ARY iNFO~'Fi~ H~ BE~ <br /> <br /> REVIEW: <br /> ............................. .............................. <br /> SEPTIC: BY DATE ~E~ PATH: <br /> Z~iNG: BY ~( ~I'E~-2'~z 5EI'BAC~: ER <br /> R~RKSt STD~E"'BE~ (~[E) ........................................................................... <br /> <br /> HEIGHT: 10 TOTAL ~ =T~ 1440 <br /> <br />FORM # MO 15-5e REV, <br /> <br />OFFICE COPY <br /> <br /> <br />