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MARION COUNTY BUILDING iNSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH S~I-REET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 _-~-~'~/~.~--- <br /> <br />of a reSis~orod builder, <br />The work will be pedormed by s registered builder. <br />Other r , <br />I have read and ~,'~e (O tR~ te~ms Stated on the rove su side of O^'i~; - <br />this document. <br /> <br />!°wNEr~ATE: ~9/21/94 TIME: 1~: ~[1~,: :~,~ TAX gOT: ~OATEGORY; <br /> <br /> ~RA~ tiff: i UGB: ~UPANT LOAD; <br /> 14397 KEIL RD NE ~ <br /> AIJBO~ O,R ~2 ~BIOH COlJ~TY, NO <br />,dSE OF BUILDINC'. NO OF BEDROOMS: <br /> <br />2578 SB <br />L~KE OSWEC0. OR 97835 SZTE NUH~Ek~ 94-~776 <br />PHONE: 638-8881 , VALUATION: <br /> <br />TYPE: ]BUILDING PERHIT OR APPLICATION ND: <br /> <br />CONTRACTOR, NO. 37543 <br /> Ore,on Pacific Construction <br />~80.~ Pacific Nwy <br />wooaourn, 97071-0000 <br />PHONE: 981-8147 <br /> <br /> ITEM <br />ADDITIONAL BUILDING FEES <br /> <br /> ~58328 <br />ARCHITECT/ENGINEER~ NO. <br /> <br />PHONE: <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS EECEIPT <br /> <br />QUANTITY AMOUNT <br /> $48.00 <br /> <br />$40.e~ <br /> <br />$4e. oe <br /> <br />BALANCE DUE <br /> <br /> PAYEE: Oregon Pacific Construction Inc 60871 <br /> RECEIVED BY: mb ................................... TYPE: CK CHECK ~: 15528 <br /> <br />I THIS IS NOT A PERHIT. THIS APPLICATION HU~T ~0 THROUGH A REVIEM PROCESS WHERE THE <br />FOLLO#IHG NUST BE COHPLETED. IT ISTHE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> LL NECESSARY IHFORNATIOH HAS <br /> <br />ZONING: BY .......... DATE .........--r~----- <br />SEPTIC: BY~-~ DA'rE~~ <br /> <br />CITY JURISDICTION= BY ........ DATE <br />REMARKS: NEED STAMPED PLANS <br /> <br />HEIGHT: SETBACKS: FR <br />TOTAL SQFT: 0 LS .... <br />STORIES: RS ........... <br />PLAN.ACTION: RR <br />ENERGY PATH= SP~ <br /> <br /> OFFICE COPY <br />FORM # MC 16.5B REV, 4/~0 <br /> <br /> <br />