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MARION COUNTY BUILDING INSPECTION <br /> <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 performin9 work on a property I own or occupy. <br />l am a registered builder OR ( ) the authorized representative <br />of a registered builder, <br />The work will be porforr~ed by a registered builder. <br />Other. <br /> <br />I have read and agree to the torrfls stated on the reverse side of <br />this document, <br /> <br /> OATE: 1,1/$0/92 TINE: ~:$4:07 <br /> GREEN JOE <br /> <br /> 11677 FALCON CT <br /> AURORA <br /> <br /> PLAN REVIEW ONLY <br />~AI&iNGAOORESS; <br /> <br /> NE <br />OR 97002 <br /> <br />PO 80X 7S9 <br />PORTLAND 97207 <br />PHONE: 685-9685 <br /> <br />SIGNATURE OF APPL CANT <br /> <br /> RESIDENTIAL <br /> <br />5-N R-,3 <br />HARTON COUNTY NO <br /> <br />N0. OF 8EOR00M$ <br /> <br />SUBDIVIStQN: <br /> <br /> CENTURY NEAOOWS <br /> <br /> SITE NUNSER: <br /> VALUATION: <br /> <br />$0.00 <br /> <br />54 33 SS 1W AR ]. <br /> 60 I10 SF YES NO <br /> <br />TYPE: BUILDING PERHIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 73977 <br /> LANAIN CONSTRUCTION <br />206 SE 4TH <br />TROUTGALE, 97060-0000 <br />PHONE: 760-7736 <br /> <br /> ITEM <br />FOOTING/FOUNDATION ONLY <br />BUILDING $TATE SURCHARGE <br />ADDITIONAL SURCHARGES <br /> <br /> 44166 <br />ARCHITECT/ENGiNEER, NO. <br /> <br />PHONE: <br /> <br />TOTAL ASSESSEO FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />ANOUNT <br /> $25.00 <br /> $0.50 <br /> $0.75 <br /> <br />$26.25 <br />$26.25 <br /> $0,,00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: <br />RECEIVEO BY: PN ..................................... TYPE: CHECK ~: 0 <br /> <br />* THIS IS NOT A PERMIT. THiS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING HUST BE COHPLETED. iT IS THE RESPONSIBILITY O( THE APPLICANT TO ASSURE T~AT <br /> <br /> PLAN REVIEW: BY ~ BriTE l%zJ-9 HEIGHT: <br /> ZONING: BY .......... DATE ........ TOTAL $QFT: <br /> <br /> PLAN.ACTION: RR ........... <br /> CZ'fY JURISDICTION: BY ........ O~TE ......... ENERGY P~I'H; SP <br /> <br /> REMARKS: FOUNDRTION FOR NH ON FILL <br /> <br /> ': OFFICECOPY <br />FORM # MC 15,56 REV. 4/90 <br /> <br /> <br />