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MARION COUNTY BUILDING INSPECTION <br />:SENATOR BLDG- NO. 22.5 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 58&5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I have read and agree to't~'~'"torm¢ ~t~te(t On the~e~erse side of <br /> <br />DATE= 12/21/90 TIME: 12:09=04 <br /> <br /> A-,t..GGC WA~LER ~ NE <br />~ OR 97002 <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> DATE <br /> <br /> TAX LOT <br /> <br /> OON~TRIJCT~ON TYPE <br /> <br />MAEiON COUN1Y <br /> <br />UGB <br /> <br /> NO <br /> <br />CATEGORY <br /> RD.E,I DEN r 1~ <br /> <br />SUBDMSION <br /> <br />CENTURY MEADONS <br /> <br /> PHONE.* 266-37?5 <br /> <br />t,OT BLOCK <br />41 <br /> <br /> TYPE: IVFg,~ [ LE <br /> <br /> CONTRACTOR, NO. <br /> r~EL. <br /> <br />19 <br /> <br /> 3 3S <br />PERMIT OR APPLICATION NO: <br /> <br />SiTE NUIVIBER:, 11943 <br />VALUA T I ON: <br />RANGE ZONE <br /> <br /> 1W AR <br /> YE~ YES <br /> <br />MAP <br /> <br />29331 <br /> <br />PHONE,: 266-27?5 <br /> <br /> I?EM <br />¢,1081LE HC~E BASE FEE <br />t.C..~ILE HOME StAi'E FF.E <br />rcF,~ILE HOME ZONING SURCHARGE <br />FLEET EURCHARGE -ZONE B <br />MO~.[LE H{,9~ STATF ,SURCHARGE <br /> <br />TOTAL ~$~ED FEE~ <br />PREV~.0US RECEIPTS <br />THiS RDiEI P1 <br /> <br />BAI..~oE DJE <br /> <br />QUANI I1Y <br /> <br />~9.25 <br />$5.25 <br /> <br /> $o.oo <br /> $0.00 <br /> <br /> PAYEE: RE:CEIRT <br /> RECEIVED BY: CL TYPE~ CHECK ~: O <br />m TH[~ IS A VALID PERMIT · THIS PER~IT EXPIRES 180 DAY~ FR[~ ITS I~E DATE. <br />~T~CT[~ C~ ~R A P~I~ OF 180 ~,OR IF~T~I~ FAI~ TO MEET ALL <br />R~IR~TS OF STATE ~ ~O ~I~ ~N~ ~ILDI~ ~O Z~[NG O~iN~, THIS PE~IT <br />~L B~E NULL ~O ~IO. <br /> <br />SETBACICS: FR 10 LS 10 R'-3 5 RR 12 <br />R~RKS~ ~ ~4400 PRIOR TO OCOJPANCY 2'~2-~T ~IOENALK ~'T ~ INSTALLED AL~G HA~LER <br /> ~E TO START OF ~E ~DiUS <br /> <br />~ALD E. ~DLE~, ~RI~ ~NTY BUILDING OFPICiAL <br /> <br /> OFFICE COPY <br />FORM # MC 15,$6 R~. 4/90 <br /> <br /> <br />