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SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE~ 588-514'7 8:00; 4::30 <br /> 24 HOLfR CODE-A-PHONE: ~88-7904 /~ ~,~'/~ /~.__ <br /> I am a. regis,ered buiMer OR )the ~uthorized Cep,esentatlVe SIGNATURE OF APPLIC~~~~ <br /> The w¢ k wil~ be per ormed by a registered builder. <br /> I have,sad a~d agree to t~ terms stated o~ the reverse side ef DATE; <br /> <br /> OA;~'E: 04Z27/92 'f;t~E: 9; 16: 25 <br />;OWNER: TAX gOT: ;CATEGORY: <br /> '1AUTP'EST, <br /> <br /> 1 ~ 3'7 1 ?AR~ RD N~ CONTRACT C)TY; UGB; ~ OCCUPANT LOAD; <br /> AURORA OR 9700~ , <br /> ~A~iO~ CQUN.~'Y L <br /> <br />UNKNOWN <br /> <br /> HUBBARD OR 9?832 <br /> S~,'~r'E NUIV~ER: 9~2-01622 <br /> PHONE: 981-3074 / VALUA'f .tUN: $140,000.00 <br />:LOT; ,BLOCK; <br /> , 05 &s ~ EFU 4 <br /> 2- ?5 AC , NO: NO <br /> <br />3 <br /> <br />f'YPE: DNELLING PERMI'I' OR APPLZCAt'iON NO: <br /> <br />CON'f RAc'r'OR, NO. <br />'f'AU'f'FEST RU~ELL. <br />3175 5'fH ~f <br />HUBBARD OR 9'7032 <br />PHONE': 981-3074 <br /> <br />if'E~ <br />L,~ELLiNG BUILDtN~ FEB <br />ONELLtN6 PLUIV~iNG <br />DNELLiNG MECHANICAL <br />[~ELLiNG ELEC'I'R~CAL <br />DNELL~NG ~'f'A'IE E:~JF,~HARGE <br />DWELLING PLAN REVIEW <br />D14ELLING ZONtN8 SU,k%~HARGE <br /> <br /> 903960? DP <br />ARCNi'FEC'F/E~./GiNEER, NO. <br /> <br />PHONE: <br /> <br />TOTAL A,~£~ED FEES <br />PR~¥~OUS RECEtP'f'S <br />!'H1$ RECEIPT <br /> <br />QUAN'I'ITY <br /> <br />AMOUNT <br /> $$'/'?.8'~ <br /> $247.18 <br /> $61.58 <br /> $193.02 <br /> <br /> $15.U0 <br /> <br />$1,438_83 <br /> $0.00 <br />$1,~38.~3 <br /> <br />BALANCE OUE $0-00 <br /> <br /> PAYEE: 'f'AU'fFEST, gU~!~E~"~ 41549 <br /> RECEIVED BY: F'B .~.~'.'.~' TYPE: CK C~ECK ~: 1058 <br /> <br />~ 'f'HiB 1~ NO]' A RER~i')'. THiS APPLtCAI'tO~ IVltJS'f' GO THROUGH A REVIEN PROCESS ~ERE 'rH~ <br />~OLLONING t~US'l' ~E CONPLE"I"ED+ JT ~S THE RES~NSJBZLiTY OF THE APPLICANT ~'0 A~URE fHA] <br />ALL NECESSARY ~NFOR~T~ON H~ BEEN <br /> <br />S~F>'~'Zr,:;; BY ....................... OATE~_ ....... b:NERGY PATH: <br /> <br />Z, DNING: BY .~, DATE ~ SE'T'BACK$: FR ~ ~ 1_5 t~ RS t o <br /> RR <br />RE~,ARKS; O~CE~G'"'AND SEP~C-'''r ................................................................................. <br /> <br />Id~GH~; TOTAL SQ P'T: 4213 S~'OR~ES: PLAN_AC F~ON: <br /> ~ ~ ¢~ ~ %~/~OFFICE COPY~ /~ ~(Z <br /> <br />DA l' E ................. <br /> <br /> ',S P .............. <br /> <br /> <br />