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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />I am performing work on a property I own or occupy. <br /> <br />The work will be performed by a registered builder. <br />Other_ <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 888-7904 ~_~_. <br /> SIGN AruRE OF AP. LI DA N,; ;~.~ <br /> <br /> DATE' <br /> <br /> :1,8SOS :~ROAD OAK BI_VD <br /> ~LOI-IA~ OR 97~07 <br /> F HONIE: 591-5205 <br />.....LOT BL6~K~ SECTION TOWNSHIP: <br /> <br />SITE NUMBER: ~K]-81§28 <br />VALUATION: <br /> RANGE: ~ ZONE: MAP' <br /> <br /> ~'~I~.' Ebm '~6 A'~; ......... 1 ..... <br /> Iqo .................. ~---- NO- ............... <br /> <br />TYPE: DWELLING PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. <br />YOLJNG~ ~HOMAS L <br />183rA5 BROAD OAK BLVD <br />ALONA,~ OR 9700'? <br />PHONE: ~01-,. _~,.~ <br /> <br /> ITEM <br />DWELLING BUlL. DING FEE <br />DWEM..ING PLUMBING <br />DWELl. lNG MECHANICAL <br />DWELLII,IG ~LECTRICAL <br />DWELl_lNG STATE SURCHARGE <br />DWELLING PLAN RE¥IEW <br />TURNPIKE D/W - BLBG INSPECTION <br />TURNPIKE D/W - PUBLIC: WORKS <br />DWELL. lNG ZONING SURCHARGE <br /> <br />PAYEE: YOUNG~ THOMAB L <br />RECEIVED ~Y: PM <br /> <br /> 9~4~818 9P <br />ARCHITECT/ENGINEER~ HO,, <br /> <br />?HONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RE6EIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> $388.93 <br /> $1:[2.65 <br /> $2A. 06 <br /> <br /> $26.88 <br /> $:[85.00 <br /> $1.00 <br /> $16.80 <br /> $I5.,00 <br /> <br /> $781.48 <br /> $781.48 <br /> <br />BALANCE DUE $0.00 <br /> 49067 <br /> <br /> TYPE: CK CHECK :~: 8S5 <br /> * THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COHPLETE~. IT IS THE RESPONSIBILITY OFTME APPLICANT TO ASSURE THAT <br />LL NECESSARY iHFORMATIONHAS BEEN PROVIBEB. <br /> <br />Pt. AN REv:r. Ew: BY~ DATE ~--~/~-~ <br /> <br />CITY JURISDICTION., BY DATE ....................... <br />F(E~ARKS'.~ RES, '~'~ I)RI~E ............... <br /> <br />liFIGHT.'.' . SETBACKS: PR <br />TOTAL SQ <br />s <br />PLAN.ACTION: RI~ ~ ~ <br />ENERGY PATN: 1 SF ........... <br /> <br />EG~M ~ MC ~-~ r~, .p~o OF FIDE COPY <br /> <br /> <br />