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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 />(~-"~- I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT: <br />( ) Other_ <br /> <br /> 10/28/91 'f'iME: 10.:51;35 TAX Lbt: ~ATEGORY: <br />ow~''f'E: ,' <br /> <br />116?2 'f'HRU~ COURT NE CONTRACT CITY; , UGB: , <br />AURORA ~ OR 9?002 <br />USE OF BUILDING'. ........... M <br /> <br />RES i DENIf 1AC ACcE~ORY' S'I'RUCTU R~ ~U~DlVlSlON; I~ <br /> . <br /> <br /> P}iON <br /> <br />LOT; <br /> <br />WIDTH: <br /> <br /> SiTE NUMBER: 12432 <br /> 'v'~gUAi~'i i ON; ....... $2,400 JO <br /> <br />DEPTH: ~ 9 ' AR~A~ ~ UN[~ IRREG. LOT~ :CORNER: <br />~ hi0 NO <br /> <br />TYPE: BULLOfNG I,;'ERMlf OR APPL,~CA'f'J, ON I',10: <br />CONTRACTOR, ND. 39990 <br /> <br />5816 St: Louis Rd <br />Gerva ~ ~, g 7025-000(,~ ~ ~...~ <br /> <br /> 11'EM <br />BUiLDiNG FEE <br />PLAN REVIBN <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br />PAYEE: Monte N~"l'ler <br /> <br /> 903638] <br />ARCH~'I'EC'T/ENGiNEER, NO. <br /> <br />PHONE: <br /> <br />I'OTAL A~,SESSED FEES <br />PREVIOUS RECEIPTS <br />f'HI~ RECEZP'f' <br /> <br />(!UANTITY <br /> <br />AMOUNT <br /> <br /> $1.93 <br /> $~ .93 <br /> <br />$5'? + 39 <br /> $0.00 <br />$(;'1. <br /> <br />BALANCE DUE <br /> <br /> RECEIVED BY: CL TYPE: CK CHECK ~: 22?8 <br /> <br />;~ rHZS IS N(,)'[' A PEF~ZT. 'f'HJS APPLICA'FiON MUST GO TBK~OUGH A REVtEW PR'OCE~ WHERE 'f'HE <br />FOLLQNiNG ~USI' BE COMPLETED. I'f' IS THE RE~S~BtLiTY OF THE APPLICAN'f' TO ASSURE 'I'HAf <br />ALL NECESSARY iNFQRf'4A'f'JON HAS BEEN PROVIDED+ <br /> <br /> E=EW: ............ ............ OA= ............ <br /> C~'f'Y JURiSOiCT'~ON; ~¥ 0A/'E <br /> <br />SEPTIC: BY DATE <br /> <br />R~ARKS: C~T ......... R~3057 ........................ <br />H~L~GH'T: 9 TOTAL SQ F'f': 249 <br /> <br />ST'ORIE~; 'l PLAN-ACTION: <br /> <br />OFFICE COPY <br /> <br /> <br />