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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM' OREGON 97301 <br /> <br /> PHON~,: 588-5147 S:O0 - 4:30 .. <br /> <br />1 am performing work on a property I own or occupy. <br />I am a registered builder OR the authorized representative SIGNATURE OF APPLICANT: ..... ~...: <br />of a registered builder, : <br />The work will be peHormed by a registered bui~der, l <br /> <br /> I hsve read and agree to the terms stated on me reverse side of ........ <br /> <br /> AUMSVZLLE OR ~97525 ~ ~fiRI;ON CeUNT~ HO <br /> <br />SINGI,E FAMT. L.Y DWELLINGS .................... I. 6 <br />PHONE: 3&~-,.6754 , VALUATION: $5,588.9~ <br /> <br />COH'[,RACTOR, NO. <br />Pf-':ARCE~ CHARLES <br />SAME <br /> <br />PERHIT OR ~PPLICAT~OH HO: ~53481 <br /> ARCHITECT/ENGINI~ER~ <br /> <br />PHONE: 36~-6954 PJ-IONE~ <br /> <br /> ITEM <br />BUILDING FFE <br />PLAN REVIEW <br />BUILDING STATE SURCHARGIE <br />ZON:rNG SURCHARGE <br /> <br />TOTAL ASSESSED FEES <br />PREVI.OUS RECEIPTS <br />THIS RECEIPT <br />B~AHCE DUE <br /> <br />QUANTITY <br /> <br />AWOUNT <br /> $56,5¢ <br /> SS&, 73 <br /> <br /> $2,, 83 <br /> <br />$98.89 <br /> $0~ 00 <br />$9I:% 89 <br /> <br />¢0,00 <br /> <br /> PAYEE: PEARCE~ CHARLES <br /> RECEIVED BY: CL TYPE: CK CHECK 4,: 4667 <br /> <br />* THIS IS NOT A PERHIT. THI~ APPLICATION MUST GO,THROUGH A REVIE~ PROCESS WHERE THE <br />FOLLOWING HUST BE COHPLETED. IT'IS THE ,'RESPONSIBILITYOF:THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY ~NFORHAT~ON HAS <br /> <br />ZONING: BY DATE ~r;~;~;~-~].~-" TOTAL SQ FT: 0 S ~ <br /> STORIES: ~ RS /~ <br /> P[nAI'I. ACT I OH: S F ].. j.'._.] <br />CITY ,JI.IRISD:[CTION: BY ................ L DATE ........................ E14ERGY PA'f H: ~IW, ~0~' EI~'-~-~'" <br />R ,~Nlxo, RIES/AI_.T FSXI~TIHG GARAt;E 'rD 6'114 BEDROOM.BATH & t:(ECRM &~S <br /> <br />FORM #:MC 15-56 REX/. ~190 OF FICE COPY <br /> <br /> <br />