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I am a registered builder OR ( ) the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder, <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />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 /> SIGNATURE OF <br /> <br /> BAILEY, .JAMES ! 41851-000 I RES:[DENTIAL <br /> SITUS AODRE$$; ~i CONSTRUCTION TYPE; <br /> <br /> 1862~ BSTTEVILLE RD NE ~ CONTRACT CITy: ~ UGB; ~O00UPANT LOA~; <br /> ~GRZClJLTUR~L STRUCTURES <br /> <br />r PHONE: 982-92~7 ~ V~LU~TION: <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION <br /> <br />CONTRACTOR, NO. <br />BAILEY, .JAMES <br />SAME <br /> <br />PHONE: 982-9217 <br /> <br /> ITEM <br />BUILDING FEE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGE <br />ZONING SURCHARGE <br /> <br /> 9~.5~772 <br />ARCHITECT/ENGINEFR~ NO,, <br /> <br />PHONE: <br /> <br />QUANTITY <br /> <br />AMOUNT <br /> $86-50 <br /> $56.23 <br /> $4.33 <br /> $4.33 <br /> <br /> TOTAL ASSESSED FEES $151.39 <br /> PREVIOUS RECEIPTS $0.00 <br /> ' T~II$ 'RECEIPT $151. <br /> <br /> BALANCE ,DUE; $0.00 <br /> PAYEE: BAILEY, JAMES 53188 <br /> RECEIVED BY: MB ................... ; .................. . TYPE: CA CHECK ~: 0 <br /> <br /> LLklI4iHI.~ HU~T BE COMPLETED. IT IS 'THE.,' .'RESPONSIBILITY 'OF THE APPLICANT TO ASSURE THAT <br />LL NECESSARY IHFORN~TION,/~/HAS BEEN, ~OV~DED;' , , , , <br /> <br /> , " ......... PLAN. ACTION: RR'"'j" ~ <br /> BI'fy JORISDIBTZON: BY' DATE ' ' ENERGY PATH: <br /> <br />REMARKS: AG/POLE BLDG <br /> <br />FORM # MC 1¢J~ REV, 4/~ OFFICE COPY <br /> <br /> <br />