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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: B88-7904 <br /> <br />of a re~lstered builder, <br />The work w~ll be performed by ~ registered builder, <br /> <br />AI,..LEN,~ I.~ [,HARD & Fi. ORA 190240-490 RES2DE~TIAL. <br /> -' i '" ~,~4,. ~ETROIT ~NO <br /> <br /> NEW~ER~ OR 97152 ~ SITE NUMBER: <br /> Pti0NE~ 5,,G- ?: ,: ~ , <br /> <br />TYPE: BUILDING PERMIT OR APPLICATION NO: <br /> <br />CllNl RACI OR,~ NO. 541,68 <br /> Tri~li.t;y Biz ~ 1. der'~ <br />4(~'3 S Sc'hoo~ <br />Newber% <br />PHONF~' 5'5~r"6278 <br /> <br />BU~L~ING FEk. <br />PL. AN REVIEW <br />BUILD];NG STAlF SURCHARGE <br /> <br /> ~057764 <br /> <br />A R C H I TE C T / E;t,I5 ,'~ NEE'R, ['JCL, <br /> <br />PHONE:' <br /> <br />PREVIOUS RECEIPTS <br />THIS EECEIFT <br /> <br />~UAN'f'Z 'T'Y <br /> <br />AHOUNT <br /> ¢80.50 <br /> <br /> $4,,~5 <br /> <br />BALANf;£ DUE $~,,~0 <br /> <br /> ~A.Y,E]E: Tri i.:~ Bu'i.'f, de-_~ <br /> RF¢,EIVED I.~Y: Pti "' <br /> <br /> * THIS I~ NOT ~ PERHIT.~, ? <br />FOLLOWING MUST BE COHPLE~E~ <br /> LL NECESSARY iNFOR~ATZO~ He <br /> <br /> PLAN REVZEij: BY <br /> g]:f'( ,JUR~Sb'i;O'f[ON: ~f ............... ])AT~ .....................ENERC;Y F'~TH~ <br /> <br /> 602~iI4 <br /> TYF ". , '"' ' -- <br />.................................. E. .Ill CI'~ECK -,% <br /> <br />;I~ ,IS ,~HE,,'. RESPONSIBILITY OF THE APPLICANT TO ASSU~E THAT <br />BEEH PR~VI~ED~ , <br /> <br />~' "'? ~ ,/" : ' CT'" , ~: ~.o. ¢-.., '>, <br /> <br /> RR" I5 <br /> S P '_'; ........ <br /> <br />FORM # MC 15-~e ~t, 4/~0 OFFICE COPY <br /> <br /> <br />