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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 I the authorized representative <br /> <br />Other <br />I have read and agree to the terms stated on the reverse side of <br /> <br />SIGHATURE OF APPLICANT;~ <br /> DATE'. <br /> <br /> ?08 STOI~E FIE.D CT ~.SE <br />AUHSVILL. E 08 ~3~5 ~E~OJ~ COUWZ~ ~ ~0 J ' <br /> <br />LOT; <br /> <br />7771 TERRANCE LANE <br />AUHSVIL. I,..E 97325 <br />PHONE: 749-2666 <br /> <br />SITE NUHBER: 73-03392 <br />VALUATION: $0.00 <br /> <br />TYPE: BUILDING PERMIT OR APPLICATIOH NO: <br /> <br />CONTRACTOR, NO. 80435 <br />Marc E Nielsen ~,t ( ,~ <br />PO Bo~ 1~178 <br />Salem, OR ~7~-88~8 <br />PHONE: ~81-~84~ <br /> <br /> ITEM <br />ADDITIONAL BUILDING FEES <br /> <br />ARCHITECT/ENGINEER, <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS EECEIP'TO <br />THIS ~ECEIPT <br /> <br />I~UAN'['I TY AHOUNT <br /> $40.00 <br /> <br />$40.00 <br /> $0.00 <br />$40.08 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: Narc E Nielsen 5327~ <br /> ~ECEIYED BY: cl ................................ = ................ TYPE: CK CHECK ~: <br />* THIS IS NOT A PERHIT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING HOST SE COHPLETE~. IT IS THE:,RESPQHSIBILiTY OF THE APPLICANT TO ASSURE THA~ <br /> LL NECESSARY INFORHATION HAS BEEN PROVIDEg. <br /> <br />ZONING: BY DATE ......... ~OTAI SQ FT: <br />SEPTIC: BY'--i::'Z]:.~'~"-']']]]']']"]'_'- I)ATE-i]]:,~.~"'"7]-"]'_"] STORIES: <br /> PC,AN; ACTION: <br />CITY JURISDICTION: BY ............ DATE ......... ENEI~I;Y PAT'N: <br /> <br />REHARKS: FOUNDATION CH~ 2X12 JOISTS TO TGI SYSTEM <br /> <br /> SETBACKS= FR <br /> 0 I,,,S ............. <br />1 RS ............. <br /> RR ...... <br />:l. s P ::: ::' :::: <br /> <br />FORM # MC 15-58 R~V. 4¢~ OFFICE COPY <br /> <br /> <br />