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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 />of a registered builder·
<br />The work will be berformed by ~ registered builder.
<br />Other_
<br />
<br /> OWNER'
<br /> REA,~ F((JE4=I~¥ ¥,+:, PIZZA PFDt)LF;:~ r I 60Hi%_'RCIAL.
<br />: SITU~ ~DD~E~'. , CONSTRUCTION TYAE: ~ O~0~; '
<br />
<br /> ~ 5-.N ~ B-2
<br /> S25 HAIN ~ J'"~'~ ~O~,.
<br /> CUH, V,I, LLI: 0R 97925 AUHSV:[.LE NO
<br />
<br /> RI~;S]'AURANT
<br />
<br /> F'0 BOX ;i09 : ...........................................................................
<br /> AUMSViLt_E Ol:,' 97,,,,,.,; ] SITE NUMBER.' B~-~167
<br /> F'HONE:i 749-4~)1~ ~ VALUATION: $5,~.~
<br />
<br />,[8'f: ~ BLobKJ , SECTION: , TOWNSHIP: J RANGE; ' ZONe: ) MAP: il
<br />
<br />TYPE: BU!LDIN6 PERMIT OR APPLICATION
<br />
<br /> Rea Constr uc'?:io~'l
<br />F'O Box 1,89
<br />
<br />F HONE,, 749-48te
<br />
<br /> 9051505
<br />
<br />A~ ,,H1 fE. CY'/t"_NG, 1NI'_'Et,,, NO.
<br />
<br />F'FIO NE:
<br />
<br /> ITEM QUANTITY A~iOUNT
<br />i(<UILDING FEE $50.50
<br />F;'LAN REVIEW $32.83
<br />BU;[I,.DIN(; STATE SURCHAR(;E $2.53
<br />
<br />,E'Ay[~%: F'ea Constl"!~(_"L':Loo
<br />
<br />TOTAL ASSES~E;D FEE
<br />F:'RI.=~V I 0US REgEIPTS
<br />THIS RFCF'IP7
<br />
<br />$85,, 86
<br /> $0.00
<br />$8,, ,, 66
<br />
<br />:SAL. ANCE DUE SfZ~. 00
<br />
<br />5:~937
<br />
<br /> RI~";E)'VI:'D BY: i::'H TYPE: IN CHECK ,'h 0
<br />* THIS I8 NOT A PERMIT. TEtS APPLICATION MUST ~O THROUGH fl REVIEW PROCESS WHERE THE
<br />FOLLOWING MUST BE COMPLETED. IT IS THE 'RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT
<br /> LL NECESSARY INFORMATION HAS BEEN PROVIDED.
<br />
<br />PLAN REVIEW: BY DATE HEIGHT:
<br />ZOl~qr, NG,: BY ............. DATE ................................ TOTAL. SQ F'T:
<br />SEPTIC: BY .................................. ~)A'TE ........................ STORIES:
<br /> :'L,AN ~ ACTION:
<br />C][]Y .JURtSD]:{:T][QN: BY DATE ENERi;Y F'ATi,,hr
<br />HEALTH DEP'T~ BY ........... ~TE ...............
<br />REH~RKS: INT RE~'"::'"EX~ST~6 RN TO'"'~]T~N-"F(OOR'"'-,, THE F'ZZZ~
<br />
<br />oEIBA,KS:, t:R /
<br /> LS"/
<br /> RS'" /
<br /> RR'" /
<br />
<br />FORM # MC 16,t~$ REV, 4,"¢0 OFFICE COPY
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