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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 8m performing work on a property I own or occupy, <br />lamaregistered buildorOR( ) the authorized representative <br />o a egis ered builder, <br />The work will be per¢ermed by a registered builder. <br />Other ......... <br />f have read and agree to the terms stated on the reverse side of <br />fms document. <br /> DATE: le/07/93 TIME: 7:19:26 <br /> <br />ic~E~CjFCEN'flAL <br /> <br /> 239 BELLEVUE BR -- <br />AUMSVILL. E OR 97325 ['c~8-f~-~tE~E~ 7~O~ ',COtb~ANt LOAD: <br /> <br /> E~'I'ATES <br />AGENT~ CRAIG LUCAS-SANTZAM HOMES <br />769-7744 <br />PHONE~ &2&-~5~l <br /> <br />TYPE: BUILOIHG PERHIT OR APPLICATIOH HO: <br /> <br />CONTRAGTO~ biO. 42256 <br />518 Valleywood Dr SE <br />Salem, 9?386-0000 <br />PHOHE: ~6~-1711 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br /> <br />ARCHITECT/ENGINEER~ NO. <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $38.50 <br /> $25.83 <br /> <br />$65.46 <br /> $0.00 <br />$65.46 <br /> <br /> ~ BALANCE DUE $0.00 <br /> <br /> PAYEE: Del NcCo?lick ~ ~287~ <br /> RECEIVED BY: DM2 ::~s-~ .... TYP~: IN CHECK $. 0 <br />~ THIS IS NOT A PERNIT. THIS APPLICATION HUST GO THROUGH A REViE~ PROCESS ~HERE THE <br />FOLLO#ING flUST SE COHPLETED. IT IS THE RESPOHSIBZLITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORNATISN HAS BEEH PROV[DED. <br /> <br />PLAN REVIEW~ <br />ZONING: BY BATE <br /> <br />CITY JURISBICTIOfl= BY ........ DATE ......... <br /> <br />HEIGHT: 10 SETBACKS: FR 11 <br />TOTAL SQ FT: ~00 LS-10 <br />STORIES: 1 R8-'10 <br />PLAN.ACTION: HR-lO <br />ENERGY PATH: SF""~___ <br /> <br />REHARKS: CARPORT <br /> <br /> OFFICE COPY <br />FORM # MC 15.56 REV. 4/90 <br /> <br /> <br />