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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 /> tam parc m ngworkonap operty own or occupy, ~ <br /> I am a registered builder OR ( ) the authorized representat ye SIGNATURE OF APPLICAN <br /> of a registered builder. <br /> The work will be performed by ~ registered builder, <br /> Other <br /> I have read and agree to the terms stated on the reverse side of DATE; <br /> this document. <br /> <br /> DATE: 09/08/92 TINE: 8:28:38 <br />OWNE~: [ T~X LO¥: dATEGORY: <br /> ROSE, FRANKLIN . RESIDENTIAL <br /> <br />SITUS ADDRESS: [ ' OCCUPANCY: <br /> ! 5-N M-1 <br /> ll344 JAMES WAY SE ??'~'~';fk. TCITY' UGB OCCUPANT LOAD: <br /> AUMSVILLE OR ~73~s J Rr'O 'COUNTY [ NO <br />USE OF BUii_~iN~i NO OF 8EOROOM$: <br />RESIDENTIAL ACCESSORY STRUCTURES <br /> <br /> 5210 RIVER ROAD N 51000 <br /> KEIZER 97303 OFFICE 393-3624 X-$50 , SITE NUMBER: <br /> PHONE: 390-9553 i VALUATION: $10,752.00 <br /> <br /> 48 <br /> <br />WIDTH; <br /> <br />TYPE: BUILDING <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. <br />ROSE, FRANKLIN <br />$210 RIVER ROAD N ~iO00 <br />KEIZER 97505 OFFICE <br />PHONE: 390-9555 <br /> <br /> ITEH <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br /> ~042404 <br />ARCHITECT/ENGINEER, NO. <br /> <br />PHONE: <br /> <br /> TOTAL ASSESSED FEES <br />' PREVIOUS RECEIPTS <br /> THIS RECEIP~ <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $86.50 <br /> <br /> $4.35 <br /> <br />$151.39 <br /> $0.00 <br />$151.39 <br /> <br /> ~:~L~NCE:OUE $0.00 <br /> <br /> PAYEE: ROSE~ FRANKLIN 44469 <br /> RECEIVEO BY: OM2 . ..~: .=,.[~,,.~ ...... ..... TYPE: OK CHECK ~: 1006 <br /> <br />* THIS IS NOT A PERMiT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLO#[N~ MUST BE COMPLETEO. IT IS THE RESPONS!GILIT¥ OF THE APPLICANT TO ASSURE THA~ <br />LL NECESSARY INFORMATION MAS:BEEN PROVIDED. <br /> <br /> PLAN REVIEW: BY __..~,[C;_ .... SETBACKS: <br /> ZONING! BY ._~.____~__ DATE~__~_.~j~_~ TOTALSQFT: 896 LS <br /> STORIES; <br /> PLAN.ACTION: RR~ <br /> CITY JURISDICTION: BY ........ DATE ................ ENERGY PATH: SP <br /> <br />REMARKS: GARAGE <br /> <br />'~ OFFICE COPY <br />FORM # MC 15,56 REV, 4/DO <br /> <br /> <br />