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MARION COUNTY BUILDING 1NSPECTI~DN <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM1 OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 ~ <br /> ) I am performir~g WOrk or~ a property I Own or OCCUpy, <br />~,'~- I Am a registered builder OR the authorized represen a ire S GNATURE OF APPL CANT~~'- . ~ <br /> of a registered builder, ' ",~ ' <br /> ) The work will be performed by a registered builder, <br /> Oth.r .tS <br /> <br />OWNER~ TAX LOT; CATEGORY: <br /> CEHTURY ~EADO~S <br /> <br />TYPE= BUILDTHG PEr~NIT OR APPLICAT!OF/ NO: <br /> <br />2564 1?th SE <br /> <br />F HBHE? ~TG-.-~ , <br /> <br />fitJ:[[.I)~l~fi FEE <br /> <br />I,:U~L~INI; sq'~l';~ SIJRCH~RI;E <br />ZONING SURCHARGe: <br /> <br /> 9057373 <br /> <br />ARC H I' T ECT/E N 5, I I,I E E'J'% IqO. <br /> <br />PHONE: <br /> <br />TOTAl. A!:;SESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />(;~UA N'[ I TY <br /> <br />AHOUNT <br /> $5~., 50 <br /> <br /> $ 2 ,, :5 <br /> $2 ,, 5;'{ <br /> <br />$8lL, <br /> <br />8ALAHCE DUE .... <br /> <br />5987? <br /> <br /> Jx:,.E,fVED ~Y,; p~b TYPE: CK CHECK ~: <br />* THIS IS NOT A PER~IT. 'THIS ~PPL~CAT~ON HUST ~O THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWtH~ HUST BE COMPLETED,. IT iS'THE' RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY INFORNATION SAS ~EEH PROVIDED. <br /> <br />TOTA_ SQ I;:'T: 4t. 8 L;S ~ <br />st) ~I ES,., RS' "~ <br />PLAN. AC'I']; 0¢I~ i:!l;! :.~Z <br />ENERGY PATH: 5F: <br /> <br />OFFICE COPY <br /> <br /> <br />