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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO. 225 <br /> 220 HIGH STREET NE <br /> [' SALEM, OREGON 97301 ,/ <br /> PHONE:588-5147 8:00- 4:30 <br /> <br /> I am ap registeregd builder OR ( ) t~/e authorized rep,esentatlve SIGNATURE OF AI~PLIC <br /> of a registered builder, . <br /> The work will be performed by a registered builder. <br /> Other. <br /> I have read and agree to the terms stated on the reverse side of OATE: <br /> t~is document, <br /> D~TE: 07/20/92 TIHE: 13:19:44 <br /> OWNER: KLEIN, LARRY : TAX lOT: <br /> <br /> 9804 HILL CREEK R0 SE <br /> ~UHSVILLE 0i 97;25 <br /> <br /> FLOODPLAIN <br />PHONE: 749-2405~~ <br /> V~LU~TZON: $[[,880.00 <br /> <br />L~T'. ~' BLOCK: FSECTtON; ' TOWNSHIP: ;~ RANGE; : ZONE; MAP: <br /> ~ ~ ~1 8S 1W ~ EFU 48 <br />]WIDTH: D~PTH ~ AREA'. 13 UNITA"C , ~R~. LOT: , CO.R: <br /> <br />TYPE: BUILDING <br /> <br />CONTRACTOR, NO. <br />KLEIN, LARRY <br /> <br />PERMIT OR APPLICATION NO; <br /> <br /> 9041357 <br />ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: 749~2405 OHONE: <br /> <br /> ITEH <br />BUILOING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br />PAYEE: KLEIN, <br />RECEIVED BY: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />LARRY <br /> <br />QUANTITY <br /> <br /> AMOUNT <br /> <br /> $60.Z3 <br /> $4.65 <br /> $4.63 <br /> <br /> $161.89 <br /> $o.oo <br /> $161.89 <br /> <br /> $0_00 <br />43404 <br /> <br /> TYPE: OK CHECK ~: 990 <br /> <br />THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWIN8 HUST BE COMPLETED. IT IS,THE 'RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORNATIONHAS 8EENPROVIOE8. <br /> <br />CITY JURISDICTION: BY ......... BATE <br />REMARKS: AO0 '0 MINK BLOC <br /> <br />HEIGHT: 16 SETRACRS; FR~ <br />TOTAL' SQ FT: 660 LS,'.7.,"~Z <br />STORIES: 1 <br />PLAN.ACTION: ~ ~L~) R R~,~,,, <br /> <br /> OFFICE COPY <br />FORM # MS t s,56 REV. 4/9~ <br /> <br /> <br />