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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 the authorized representative OIGNATURE OF APPLIGANT <br />of ~ registered builder, <br /> <br />Other <br />The work will be performed by a registered builder, <br /> <br /> r~ A"I' S,, F,t%HAH3 I:~F_':S I DENT i AL <br />AbDR~i [ dONSTRUCT O~ ~YPE; ~ OCCUPA~b¢: <br /> <br /> AUHoVIL. I..E.{'' OR 97;25 ~R¢.DN COUNTY NO <br /> <br /> SITE NU~BER: ~3-~2817 <br /> PHONE: ' , =o .-.)~ ~ <br /> 749 -1. ~,l VALUATION: ¢11 ,~ J ........ <br /> <br />TYPE: ~UILDIN~ <br /> <br />CoI,r.f. RACTOR,, NO. <br />BAT!i),~ RICHARd) <br /> <br />PERMIT OR APPLICATION NO: 9849185 <br /> <br /> ARCHII FCT/!:':NG.[N[:.EE~ NO,, <br /> <br />PFIOI,IE:: 749-1521 PHONE::: <br /> <br /> 'ITEH QLIAN'f ]:TY AHOUHT <br />BUILDING F'EE ,' ° <br />PLAN REV.[E"W $60.13 <br />BUTLBIN6 STATE SURCHARGE $4.63 <br />ZONIHG SURCHARGE , $4. <br /> TOTAL ASSEssED FEES $,t,S'l. <br /> :: FmRE~IOUS' RECE'rPT8 $0~ 00 <br /> · THI,9 :RECEIPT $16:l., 89 <br /> <br /> : B~LANCE, ": $0.00 <br /> <br /> PAYEE:: RICK BATS COH~T. ;:INC;, 51532 <br /> RECEIVEI) BY: DM2 , , 'TYPE: CK CHECK ,~: 2612 <br />* ~HIS IS NOT A PERMI:T. THIS APPLICATI,OH HBsT gO THROUG~ A REVIEW PRQCESS WHERE THE <br />FOLLOWING MUST BE CO~PLETE~; :~T IS THE RESPONSiBiLiTY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORMATION HAS:EEEH PEOVIgEg. <br /> <br /> "FR <br /> LS'"'~"~' <br /> <br /> CITY JURISD:[C'fIOH~ BY ........ ......... DATE ............................... ENEIr46Y PAZH: <br /> ~E~Af{kS. ~ARAGE <br /> <br />FORM # MC 1 ¢-e6 R~'V, 4/90 OFFICE COPY <br /> <br /> <br />